Community Referral Request. Help is Finally HERE.

Clare Senior Care AFC & GAFC LLC

100 Hancock St

Unit 304 (3rd Floor)

Quincy Ma 02171

781-400-3541xt

Name of Referral Source: *

Referral Phone Number: *

"You will receive an invitation to join a HIPAA-compliant communication portal where you can securely upload your client's medical records, IDs, and insurance card. If you do not have documents to upload, there is no need to join this is optional *

Referral Email Address

Company Name

Check this if you are an employee of Clare Senior Care AFC/GAFC

Name of Client needing help *

Name of Contact (caregiver ) person if not client

Client / caregiver Phone number

Client/Caregiver email Address

Does this client have MassHealth Standard?

Yes

Interested in our AFC/GAFC program?

"Our Care Coordination agency stands apart from the rest! As a MISSION-DRIVEN AFC/GAFC homecare provider, we are committed to making a meaningful impact on our community by delivering care at the right time and in the right place for every member we serve. Our ALL-INCLUSIVE care model goes beyond expectations, providing each member with an IPAD equipped with unlimited WIFI and DATA, ensuring they stay connected and supported. We’re here to ease the care burden for family members and case managers alike. Finally, help is here—making care simpler, more efficient, and compassionate."

Please Click which program you like to refer your client to eligibility for program(Masshealth standards + Clinical eligibility) .

AFC (Live with someone)

GAFC (Seniors live alone)

Private Pay

Any Documents you feel is helpful for us to have while assisting this client, such as eviction notice, late utility bills, insurance denial letters. DO NOT UPLOAD IDs, MEDICAL here. This is not HIPPA. Our processing time is about 1week. Please inform your client a Clare Staff will contact them within 1 week of submission of this request. Thank you!