Refer a Patient for Care or Placement

For Maryland hospital discharge teams, case managers, and care coordinators. Tell us what your patient needs and a CareBridge coordinator will reach out using your preferred contact method.

If this is an emergency, call 911. Do not submit highly sensitive medical or financial information through this form — no diagnoses, Social Security numbers, insurance ID numbers, or medical records. Any later exchange of protected health information will use an approved, secure, HIPAA-appropriate process.

Referring organization *

Your name *

Professional role

Work email *

Work phone

Preferred contact method

Type of care or placement needed

Desired county or ZIP code

Expected discharge timeframe

Payment category

Mobility / general support level

I confirm I am authorized to request care coordination on behalf of this patient/family, and I consent to be contacted by CareBridge. I understand this form is not for emergencies and that protected health information must not be submitted here.