In addition to this form, please fax current history and physical, medication list, and the last two weeks of nursing notes. Thank you for your referral. We will review the information and contact you within 1 business day. 

Any additional questions please contact:

Jeanine Ryan 
[email protected]  
Phone: 218-722-1501 
Fax: 218-722-5882   

Referral Form 

County information: 

Medical information:

Referral Contact number: 

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