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Rehabilitation Referral Forms for Physicians

A physician’s referral is required for most programs at NYU Langone’s Rusk Rehabilitation. The required forms are listed below:

Referral Information for Medical Facilities

To initiate a referral to Rusk Rehabilitation, the patient’s current social worker should review our discharge checklist and use Allscripts or fax to send the appropriate medical records to 212-263-8510. These should include the following:

  • face sheet, including demographic and insurance information
  • medical history and physical
  • active medication list
  • most recent lab results from the last 48 hours, including complete blood count and basic metabolic panel; last 3 sets of labs
  • diagnostic and imaging reports
  • medical consults, such as cardiology, neurology, gastroenterology, ophthalmology, or endocrinology
  • notes from the last 72 hours as well as initial notes
  • notes from physical therapy, occupational therapy, and speech–language pathology therapy
  • most recent progress notes from the primary team
  • operating room notes, if applicable
  • social work assessment, including information about the patient’s social situation, to allow our team to create a post-rehabilitation plan
  • nursing unit phone number
  • resident and attending physician phone numbers

After Rusk Rehabilitation’s outreach and admissions team receives this information and the referral, a member of the clinical liaison team contacts the referring social worker, the patient, and if appropriate, the patient’s family. To contact the outreach and admissions team, please call 212-263-6034.