Providence Online Guest Stay Request

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
* Name of Doctor or Medical Professional
* Referring Persons Role
* Referring Person Name
* Referring Person Phone
* Referring Person Email
* 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





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


4. Additional Information

* Is the family aware that our check in time is between 9am and 8pm?
* Please make family aware that we ask for a $10 fee per night to help cover the cost of their stay. Are they able to contribute at this time?
* Are both parents over 18 yrs?
* 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.
* 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
* Have all family members signed the Conditions of Stay form?

Notes regarding this request:




Acceptance

Thank you for submitting the referral. A Ronald McDonald House Charities of New England Providence 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 401-274-4447. 



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