Health Care Professionals –

Click here to review the referral process flow chart.

Next, read over the following documents with your patient.

Screening Evaluation Form

Respectful Living Covenant

Mission Hospitals Authorization to Release Medical Records

Directions: Fax completed forms to Haywood Street Respite at 828-348-0933 along with H&P and other pertinent documents. Call respite at 828-575-2477, ext 102 to confirm that fax was received.  Haywood Street personnel will evaluate the appropriateness of your patient and will contact you by phone to confirm approval.

  • While reservations are not possible, a phone call to explore appropriateness of referral and inquire about openings is welcome.
  • Referral must be submitted before 2:00pm
  • Discharge Instructions must accompany patient to Respite.
  • Patients must arrive at Respite with medications according to Discharge Instructions
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