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Rathbun Room Request Referral

Referrals accepted from: Hospital-based social workers, case managers, discharge planners, nurse navigators and House Supervisors. NOTE: Referrals accepted 48 hours in advance (exception: Monday referral made on a Friday). NEW REFERRALS ARE NOT ACCEPTED AFTER 5 pm. New check-ins not accepted after 7 pm. Referrals after 5pm will be processed the next day.

Please review this exclusion criteria before filling out the web form below. If these situations are present do not refer:

  • A person who has had risky behavior with known security concerns including violating Rathbun agreement and has been asked to leave Rathbun Center in the past. Individuals who have exhibited signs of inappropriate and/or impaired behavior with known security concerns in the hospital are not eligible to be guests at Rathbun.
  • A person who shows active impairment
  • A parent who can visit in PEDS/PICU or NICU, but only with supervised visits
  • A parent who does not have custody of the pediatric patient
  • A person with fragile, medical concerns
  • A person with recent suicide history
  • A person who is not eligible to be assigned to a NICU Sleep Room

- Do not give guidelines/instructions page to patient/guest.
- Ask questions to the guest either by phone or in person.

Section A

If the person answers yes to any of these first 3 questions, please have further discussion before continuing with the rest of the screening tool.

  1. Have you ever been asked to leave the Rathbun Center in the past?

    Yes or No

  2. To the best of your knowledge, have you, your family members, or others who plan to stay at the Rathbun Center been exposed to any infectious or contagious disease in the past 3 weeks including but not limited to: influenza, chicken pox, shingles, hepatitis A, mumps, measles or tuberculosis?

    Yes or No

  3. Do you or others guests staying with you have any legal restrictions?

    Yes or No

    If yes, what are the restrictions?

If guest answers yes to one of the first 3 questions on the application further steps are necessary to determine if they are appropriate.

  • A positive response to question #2 requires a call to Infection Prevention. In the event of exposure, the guest must be cleared by Infectious Disease before they will be accepted as a guest. Call 213-5460 or 776-5216.
  • A positive response to question #3 about legal restrictions requires a phone call to Risk at 213-5500 or call the House Supervisor to be connected to someone from Risk after hours.

If guest is not ruled out in section A, ask the questions in section B.

Section B

If answers are no to all of the above questions please continue.

  1. Are you 18 years of age or older?

    Yes or No

  2. Do you have a photo ID with you?

    Yes or No

  3. Are you aware you will need to provide a $20 refundable deposit upon check-in?

    Yes or No

  4. Are you a permanent resident outside of Buncombe County, NC?

    Yes or No

  5. Are you capable of taking care of your own medical/personal needs?

    Yes or No

  6. If you answered no to #5, Do you have a caregiver with you?

    Yes or No or N/A

    (Guests coming in for cancer treatments, surgery or dialysis outpatient or the night before surgery must be accompanied by an adult caregiver. (Any exception requires approval from Rathbun House Manager).

  7. Do you have a service animal and do you understand that you are responsible for its care at all times.

    Yes or No or N/A

    (If so, you are responsible for all of the animal’s needs and must accompany you at all times. The animal cannot be left at the Rathbun Center unattended)

  8. Do you agree to accompany minor children at all times?

    Yes or No or N/A

  9. Do you agree to follow the No alcohol, No illicit drugs, and No tobacco Rule?

    Yes or No

    (Alcohol, illicit drugs, and tobacco are prohibited in all areas of the Rathbun Center including the house, guest rooms, parking lot and property. Violation of this policy will result in immediate release of the guest’s room.)

  10. Do you agree to follow the 4 person/room maximum policy?

    Yes or No

    (Any additional individuals will need to be screened and approved by the Rathbun Center staff prior to their stay. Typically these 4 guests remain constant, however if you need an exception to this Rathbun House Manager approval is necessary.)

  11. Special Needs (affirmative answers are not a guarantee of accommodation. Accommodation based on room availability):

  12. Please identify any language, hearing, or reading needs

  13. Please identify any handicapped needs or limited mobility (wheelchair, walker, cane, etc.)

If you have determined, based on this guest screening tool that the person is a good candidate for Rathbun, please fill out the Rathbun Referral Web Form below.

If you indicate secondary adult guests will be accompanying the primary guest, the primary guest will be contacted by Rathbun staff for contact information and additional screening.