Refer for home and community support
Families, friends, case managers, and other referral partners can request IHS with training, IHS without training, night supervision, and other Clemens Health services. Share the person's needs and proposed schedule so we can discuss fit and availability.
What to have ready
- Your contact information, relationship to the client, and permission to share referral details.
- The person's initials, age range, city or ZIP code, county, and living arrangement.
- The requested service, waiver type, and proposed weekly hours.
- Preferred days or nights, urgency, and the support currently in place.
- A short description of the goal or assistance needed, including communication preferences.
State what is authorized and what still needs assessment or approval. Keep the initial description focused on what is needed to evaluate the referral.
You can attach relevant documents in the form. Read the full referral checklist for file limits and follow-up questions.
This form currently has adult age ranges. For someone under 18, contact us first to discuss age and service fit. Do not select an inaccurate age to continue.
Choose the service to discuss
- IHS without training
Support using or maintaining current skills during everyday activities.
- IHS with training
Practice toward an adult's goals at home or in the community.
- Night supervision
Assistance with assessed nighttime needs. Specify the awake staffing requirement, if any.
Before relying on a start date
A submitted referral does not confirm staffing or reserve hours. Ask the intake team to confirm service fit, coverage at the person's address, the proposed schedule, and any remaining authorization steps. Discuss worker continuity, backup coverage, and the contact for schedule changes before the first visit.
Our office is at 7800 Metro Pkwy, Suite 110-11, Bloomington, MN 55425. Contact us about the specific Twin Cities location where support is needed.
View the Minnesota DHS record for license 1115332Looking for help for yourself or a family member and unsure about the service or waiver? Start with a conversation. You do not need to complete a professional referral to ask a question.
Your info & the client
Your contact info
Client basics
Select all that apply.
Client documents (optional)
Only include documents you have permission to share. Files are sent when you submit the referral.
Practical tools for referral coordination
Keep referrals, authorizations, schedules, transitions, and follow-up decisions clear. Each guide includes an editable worksheet.
- Writing a concise HCBS referral service brief
Prepare a provider-fit conversation with a short brief separating requested services, known facts, and unresolved questions.
- Authorization and staffing: two separate confirmations
Track service decisions and provider availability separately before relying on an IHS or night-supervision start date.
- Planning a change of HCBS provider
Prepare a transition discussion that records the person’s choice, open decisions, proposed dates, and handoff responsibilities.
- Mapping a week of home and community support
Make service times, purposes, responsible contacts, and unresolved overlaps visible in a weekly planning worksheet.
- Following up on an HCBS referral
Track the last confirmed fact, missing information, responsible contact, and next decision without repeatedly resending the same packet.
- Preparing an IHS or night-supervision service review
Bring the person’s experience, planned-versus-actual support, and clear decisions into a structured service-review conversation.