Please select your preferred stay location (Boston or Providence) from the tabs at the top *******Guest Stay Request for Social Workers/Referrers********

1. Stay Request

2. Patient Information

* Patient's Age
* Referring Persons Role
* Referring Person Name
* Referring Person Phone
* Referring Person Email
* Name of Doctor or Medical Professional
* Vaccinated?
* Unvaccinated patients, advised by their medical team, know that they must have a Negative PCR test for Covid w/in 72 hours of staying here

3. Guest Information

* Are All Guests Staying Here Fully Vaccinated? This is required.
* Is the address provided the families permanent address?
* Has This Family Stayed Here Before?
* Name of Emergency Contact for Parent
* Phone of Emergency Contact for Parent
* Need Parking Space?
* Any Special Requests/Needs? Disability accessible room? Please detail below

4. Additional Information

* Are both parents over 18 yrs?
* Does family need housing from 3 to 90 days? If No, please call us for consideration of a different stay length.
* Any safety or social concerns? Drug abuse,child abuse, DCF/DCYF involvement, domestic violence, felonies, etc? If so, Please call RMHC to discuss.
* Are you aware of any Infectious/Contagious Diseases in the family? If so, contact us.
* Has any family member been newly diagnosed or developed a new skin rash in the past 4 weeks. If so, please call RMHC directly to discuss.
* Is Patient Staying in RMHC housing?
* Is patient 21 or younger? Or High-risk pregnancy?
* Is an Interpreter Needed? Note that interpreters are required for checkins and checkouts and 24/7, and provided by the hospital
* Family knows check in is 9-5
* Apartment will be occupied 5 nights/wk
* Caregiver can care for themself and Patient Independently

Notes for this request: Only 1 parking space is available per apartment


Thank you for submitting the referral. Note that we typically are full and have a waiting list. When the referral has been reviewed, a Ronald McDonald House Charities of New England Boston staff member will contact you within 24 hours weekdays. Referrals received over the weekend will be responded to on the following Monday.  If you do not hear from us by then-feel free to give us a call at 617-398-6458. 


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