{"id":434,"date":"2023-04-06T14:33:00","date_gmt":"2023-04-06T18:33:00","guid":{"rendered":"https:\/\/ablehealthcarema.com\/?page_id=434"},"modified":"2023-06-06T12:51:02","modified_gmt":"2023-06-06T16:51:02","slug":"referrals","status":"publish","type":"page","link":"https:\/\/ablehealthcarema.com\/?page_id=434","title":{"rendered":"Referrals"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"434\" class=\"elementor elementor-434\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2353d135 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2353d135\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4cd2b460\" data-id=\"4cd2b460\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-4006f1d6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4006f1d6\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-4ac90191\" data-id=\"4ac90191\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4a5e6ab9 elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"4a5e6ab9\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInLeft&quot;,&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Referrals<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-134d8bb elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"134d8bb\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3646733e elementor-icon-list--layout-inline elementor-align-end elementor-mobile-align-center elementor-list-item-link-full_width elementor-invisible elementor-widget elementor-widget-icon-list\" data-id=\"3646733e\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInRight&quot;,&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/ablehealthcarema.com\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Home<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-chevron-right\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Referrals<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7ce36c99 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7ce36c99\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-acf0f93 elementor-invisible\" data-id=\"acf0f93\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeInRight&quot;,&quot;animation_delay&quot;:400}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-21fca4a elementor-widget elementor-widget-heading\" data-id=\"21fca4a\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">PLEASE CALL OUR OFFICE:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3d6ff37e elementor-view-stacked elementor-position-inline-start elementor-mobile-position-inline-start elementor-shape-circle elementor-widget elementor-widget-icon-box\" data-id=\"3d6ff37e\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-phone-alt\"><\/i>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tCall us\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tPhone: (413) 417-7538<\/br>\nFax: (413) 417-7543\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1d80b35e elementor-view-stacked elementor-position-inline-start elementor-mobile-position-inline-start elementor-shape-circle elementor-widget elementor-widget-icon-box\" data-id=\"1d80b35e\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"mailto:mshilasi@ablehealthcarema.org\" class=\"elementor-icon\" tabindex=\"-1\" aria-label=\"Email us\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-mail-bulk\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<a href=\"mailto:mshilasi@ablehealthcarema.org\" >\n\t\t\t\t\t\t\tEmail us\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tmshilasi@ablehealthcarema.org\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-24ce1910 elementor-view-stacked elementor-position-inline-start elementor-mobile-position-inline-start elementor-shape-circle elementor-widget elementor-widget-icon-box\" data-id=\"24ce1910\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-map-marked-alt\"><\/i>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tHolyoke, MA\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\t1111 Elm Street, Suite 8<\/br>West Springfield, MA 01089\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-27aca01 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"27aca01\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6136fdfa elementor-widget elementor-widget-heading\" data-id=\"6136fdfa\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">New Clients may be referred by:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-de53818 elementor-align-start elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"de53818\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Nursing Homes<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Self Referral<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Caregivers<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Insurance Companies<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Physician<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Hospital<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4a2f4241 elementor-invisible\" data-id=\"4a2f4241\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeIn&quot;,&quot;animation_delay&quot;:200}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a784317 elementor-widget elementor-widget-text-editor\" data-id=\"a784317\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Please fill out the application below if you would like to submit a referral. We operate 7 days a week, 24 hours a day. It is our pleasure to offer our services to you.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ac64157 elementor-widget elementor-widget-form\" data-id=\"1ac64157\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;,&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Make A Referral\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"434\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"1ac64157\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Referrals\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"434\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_2eb1a5d elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Referral Source\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_4cd0058 elementor-col-100\">\n\t\t\t\t\t<h6>Referral Source:<\/h6> \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e5f92be elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e5f92be\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPRIMARY NEEDS FOR HOME CARE (CHECK ALL THAT APPLY)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nursing Homes\" id=\"form-field-field_e5f92be-0\" name=\"form_fields[field_e5f92be]\"> <label for=\"form-field-field_e5f92be-0\">Nursing Homes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Self Referral\" id=\"form-field-field_e5f92be-1\" name=\"form_fields[field_e5f92be]\"> <label for=\"form-field-field_e5f92be-1\">Self Referral<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Caregivers\" id=\"form-field-field_e5f92be-2\" name=\"form_fields[field_e5f92be]\"> <label for=\"form-field-field_e5f92be-2\">Caregivers<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Insurance Companies\" id=\"form-field-field_e5f92be-3\" name=\"form_fields[field_e5f92be]\"> <label for=\"form-field-field_e5f92be-3\">Insurance Companies<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Physician\" id=\"form-field-field_e5f92be-4\" name=\"form_fields[field_e5f92be]\"> <label for=\"form-field-field_e5f92be-4\">Physician<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Hospital\" id=\"form-field-field_e5f92be-5\" name=\"form_fields[field_e5f92be]\"> <label for=\"form-field-field_e5f92be-5\">Hospital<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPhysician\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Physician\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Email\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-message elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPhone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Phone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_fb44316 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Patient Demographics\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ef84dcc elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ef84dcc\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPatient's First Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ef84dcc]\" id=\"form-field-field_ef84dcc\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Patient&#039;s First Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3b431e6 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3b431e6\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPatient's Last Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3b431e6]\" id=\"form-field-field_3b431e6\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Patient&#039;s Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_a3eb85a elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a3eb85a\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDate of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_a3eb85a]\" id=\"form-field-field_a3eb85a\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field\" placeholder=\"Date of Birth\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_1d40164 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1d40164\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPatient's Email\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_1d40164]\" id=\"form-field-field_1d40164\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Patient&#039;s Email\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f3ce249 elementor-col-66\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f3ce249\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tStreet Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f3ce249]\" id=\"form-field-field_f3ce249\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Street Address\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4d95b87 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4d95b87\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tApt\/Suite #\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4d95b87]\" id=\"form-field-field_4d95b87\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Apt\/Suite #\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_01d991f elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_01d991f\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_01d991f]\" id=\"form-field-field_01d991f\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"City\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_8aa9876 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8aa9876\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tState\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8aa9876]\" id=\"form-field-field_8aa9876\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"State\">State<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Massachusetts\">Massachusetts<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Connecticut\">Connecticut<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Other\">Other<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_74b3c17 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_74b3c17\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tZip Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_74b3c17]\" id=\"form-field-field_74b3c17\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Zip Code\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0e3b630 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0e3b630\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPatient's Diagnoses\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0e3b630]\" id=\"form-field-field_0e3b630\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Patient&#039;s Diagnoses\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_34fd407 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_34fd407\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPatient's Insurance Information \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_34fd407]\" id=\"form-field-field_34fd407\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Patient&#039;s Insurance Information \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_09a4643 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Primary Needs\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_baa6a68 elementor-col-100\">\n\t\t\t\t\t<h6>Primary Needs for Home Care:<\/h6> <i>(Check all that apply)<\/i>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_b98670d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b98670d\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPRIMARY NEEDS FOR HOME CARE (CHECK ALL THAT APPLY)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Medication Management\" id=\"form-field-field_b98670d-0\" name=\"form_fields[field_b98670d][]\"> <label for=\"form-field-field_b98670d-0\">Medication Management<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Disease Process Education\" id=\"form-field-field_b98670d-1\" name=\"form_fields[field_b98670d][]\"> <label for=\"form-field-field_b98670d-1\">Disease Process Education<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Coumadin \/ INR Management\" id=\"form-field-field_b98670d-2\" name=\"form_fields[field_b98670d][]\"> <label for=\"form-field-field_b98670d-2\">Coumadin \/ INR Management<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Physical Therapy\" id=\"form-field-field_b98670d-3\" name=\"form_fields[field_b98670d][]\"> <label for=\"form-field-field_b98670d-3\">Physical Therapy<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"GAFC \/ PCA Services\" id=\"form-field-field_b98670d-4\" name=\"form_fields[field_b98670d][]\"> <label for=\"form-field-field_b98670d-4\">GAFC \/ PCA Services<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Homemaker \/ Companionship\" id=\"form-field-field_b98670d-5\" name=\"form_fields[field_b98670d][]\"> <label for=\"form-field-field_b98670d-5\">Homemaker \/ Companionship<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_6c108f0 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6c108f0\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tAny additional information?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_6c108f0]\" id=\"form-field-field_6c108f0\" rows=\"4\" placeholder=\"Any additional information?\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-md\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit Referral<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Home PLEASE CALL OUR OFFICE: Call us Phone: (413) 417-7538 Fax: (413) 417-7543 Email us mshilasi@ablehealthcarema.org Holyoke, MA 1111 Elm Street, Suite 8West Springfield, MA 01089 New Clients may be referred by: Nursing Homes Self Referral Caregivers Insurance Companies Physician Hospital Please fill out the application below if you would like to submit a referral. [&hellip;]<\/p>\n","protected":false},"author":10,"featured_media":0,"parent":0,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-434","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/ablehealthcarema.com\/index.php?rest_route=\/wp\/v2\/pages\/434","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ablehealthcarema.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ablehealthcarema.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ablehealthcarema.com\/index.php?rest_route=\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/ablehealthcarema.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=434"}],"version-history":[{"count":22,"href":"https:\/\/ablehealthcarema.com\/index.php?rest_route=\/wp\/v2\/pages\/434\/revisions"}],"predecessor-version":[{"id":2128,"href":"https:\/\/ablehealthcarema.com\/index.php?rest_route=\/wp\/v2\/pages\/434\/revisions\/2128"}],"wp:attachment":[{"href":"https:\/\/ablehealthcarema.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=434"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}