For home health agencies & facilities

Submit a facesheet — quickly and securely.

Upload the facesheet and referral details below. It goes straight to our intake team over an encrypted connection — no fax, no email attachments — and we confirm within 24 hours.

HIPAA-compliant Encrypted in transit & at rest BAA available Confirmed within 24 hours

Your organization

Facility / agency name *

Organization type

Your name *

Phone *

Work email

Patient

Patient name *

Date of birth

Insurance

Wound type

Notes for our intake team (optional)

Documents

Drop the facesheet here, or tap to browse PDF or photo · insurance card photo helps too · up to 5 files I'm authorized to share this patient's information with Advanced Mobile Wound Care Illinois for treatment and care-coordination purposes.

Encrypted upload (TLS) · seen only by our intake team · every access is logged.
Prefer the phone? Call (773) 389-7743.

What happens next

We confirm receipt within 24 hours — usually the same business day, by phone or portal.

We verify coverage — Medicare Part B and most plans, billed directly. No cost to your facility or agency.

The first visit is scheduled — typically within 48 hours, and you can follow every step in the portal.

Do this once with a login

Sign up for portal access

Live status on every referral — received → reviewing → accepted → scheduled → seen Visit notes & orders for your patients after every visit Direct, secure messaging with the treating provider A calendar of exactly which days we're seeing which of your patients HIPAA-compliant — encrypted, access-logged, BAA on file

How we protect PHI

Uploads are encrypted in transit (TLS) and at rest, stored in systems we control — never third-party form processors or email inboxes. Every view of this record is written to a HIPAA audit log, and a Business Associate Agreement is available for your compliance file.