Refer a Child

For discharge planners, case managers and physicians arranging pediatric home health in Georgia. This form starts a conversation — it is not the clinical packet, and nothing here commits either side.

Submit a Referral Referral Guidelines

About you

Your name

Your role

Hospital or organization

Work email

Direct phone

About the referral

Where are things in the timeline?

Planning aheadDischarge is scheduledTime-sensitive

County or city in Georgia where the child will be at home

Please do not send patient records through this form

This form is not a secure channel for protected health information. Do not attach or paste patient records, PHI or documents. Share only what is needed to start a conversation — we will arrange a proper route for the clinical detail once we are talking.

Anything that would help us pick up the conversation (optional)

Up to 800 characters.

I am authorized to make this referral on behalf of my organization, and I confirm I have not included patient records or protected health information in this form.

How Referrals Work

What happens after you send this form.

1
We review the referral
Our team reviews it and confirms who is handling it.
2
We contact you
We talk through the child's needs and agree a secure route for any clinical documentation.
3
We coordinate care
If we are the right fit, we reach out to the family and work with the ordering physician. If we are not, we will tell you plainly.

Please keep records out of this form

This form is not a secure channel for protected health information. Do not send patient records, charts or documents through it. Once we are in contact we will agree a route that is appropriate for the clinical detail.

Would you rather pick up the phone?

If a discharge is moving quickly, call the team directly and we will take the referral that way.

Call (470) 645-9079

Fax: (678) 884-0561
Email: care@welivehealthcare.com

WeLIVE Healthcare Services provides pediatric home health in Georgia. We do not determine Medicaid eligibility or approve Georgia Pediatric Program hours. For a medical emergency, call 911 — please do not use this form. See our privacy policy.

Questions About a Referral?

Our team is here to help you and your patients' families every step of the way. Call us, or send the referral and we will follow up.

Contact Our Team (470) 645-9079