To move forward in the admission process, please download and complete the forms below. Once the admission forms are complete, please sign and mail or fax them to:
Rose Hill Center
5130 Rose Hill Blvd.
Holly, MI 48442
(For your convenience, these forms can also be filled out using the interactive PDF forms linked below. Complete the form as directed, save the file to your computer and then email it as an attachment to firstname.lastname@example.org.)
Physician Referral — This form is to be completed by the current attending psychiatrist and should also include supporting documents such as lab results and psychiatric evaluations. NOTE: If the Rose Hill applicant is hospitalized, this form should not be completed by the hospital psychiatrist but rather the treating psychiatrist prior to hospitalization.
Benefit Contact Information — This form must be completed as part of the application and can be done by either the applicant or the applicant’s family. Copies of the required documents listed under the heading “Necessary for Admission” must be mailed or faxed to Rose Hill Center. (Note: Be sure to copy both sides of any two-sided documentation, i.e., insurance card, driver’s license, etc).
Financial Form — This form must be completed by the individual who will assume financial responsibility for the patient while at Rose Hill Center.
Patient Application — This form must be completed only by the patient applicant. (Note: If the patient is too ill to complete this form, the Director of Admissions may determine that it is not required for admission).
Release of Information — This form should be printed out, signed and forwarded to the medical records department of any hospital where the patient has been treated for psychiatric diagnoses. For your convenience, we have provided this form although some hospitals may require that you use only their form. NOTE: Rose Hill’s Admissions Department is available to follow up with the hospital(s) after you have signed the release of information form and spoken with the medical records department. Please provide us with the name and phone number of the hospital along with the name of the medical records personnel with whom you spoke.
If the applicant is currently hospitalized, advise the hospital treatment team of your interest in Rose Hill Center prior to discharge and ask them to call Laura Mueller, Director of Admissions at 248-531-0341. We understand the critical time constraints of hospital admissions and discharges and can respond promptly to work with the hospital therapy team on plans for discharge to Rose Hill Center.
Face-to-face interview – After review of the clinical information and Rose Hill application forms, the Director of Admissions will make arrangements with the applicant and their family for a pre-admission interview. This can take place at Rose Hill Center, in the applicant’s geographic vicinity or, if hospitalized, at the hospital.
The decision – The entire application and clinical information is carefully reviewed by the Admissions Committee. The Director of Admissions will notify the applicant of the admission decision by the Admissions Committee and arrange an admission date and time.
Preparation for admission – The Director of Admissions will advise you of a date and time for admission. It is a licensing requirement that you must have a physical exam completed by a medical doctor, not more than 30 days prior to admission to Rose Hill Center. NOTE: If you are coming directly from a hospital to Rose Hill, we can obtain this physical exam information from the hospital records.
The following may be useful in your preparation for admission:
Day of admission – When you arrive at Rose Hill Center, you and your family members will have an opportunity to meet Rose Hill Center staff and other residents, get settled into your room and complete the paperwork necessary to finalize your admission.