Complete Referral Application

Patients that are referred to us from a Detox Unit or a Crisis Stabilization Unit must attach four days worth of doctor’s progress notes (or documentation from all days if patient has been in your care < 4 days ), history & physical, lab results and a medication list before the referral can be reviewed by our medical team. If approved by our medical team and the potential patient has active insurance, that we are credentialed to accept, then we can provide them a tentative bed date.

All patients must be willing to consent to a Coronavirus test and a flu shot either prior to their arrival or upon their arrival at Mountaineer Recovery Center. If patients receive their COVID test or flu shot prior to their arrival documentation must be provided from a medical facility.

In compliance with the Health Portability and Accountability Act “HIPAA” (rule 104-91), this completed referral and any attachments are intended only for use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law.