Request for Private Duty RN, LPN or Certified Nursing Assistant

CNA (Certified Nursing Assistant): Recording vital signs (temperature, pulse, blood pressure), assisting with bathing, positioning, massage, assisting with activities of daily living such as eating, toileting, bathing, positioning, massage & assistance with ambulation are examples of the duties and responsibilities of a CNA. Families are often concerned their loved one may have to wait a long period of time to have a call button answered due to the nursing shortage. A CNA can meet all of these needs, and for most private duty requests, give the patient undivided attention. Having a private duty health care provider gives family members peace of mind when they are not with the patient. Although a CNA cannot give medications, the CNA can go to the Staff RN and request the medication from the Staff RN. The CNA can continue to advocate for the patient until the pain medication is received.

LPN (Licensed Practical Nurse): All of the activities listed above with the addition of medication administration, including pain medication and insulin. By definition, a LPN practices nursing tasks and responsibilities within the framework of supportive and restorative care under the direction of a registered nurse. In a hospital setting, a  LPN cannot work in critical care or the ED – usually assigned to med/surg, sub-acute or rehabilitation units. The LPN is an ideal candidate for private duty based on his/her ability to administer medications. The LPN is more expensive than a CNA but not as expensive as a RN based on educational and licensure requirements.

RN (Registered Nurse): There are clinical situations in which the higher skill level of a RN may be necessary, for instance, complex patient situations in which the greater knowledge and experience of a RN may be warranted. However, families should be informed that most hospitals do NOT allow private duty RN’s to give medications. Administration of pain medication is often the primary reason a family requests a nurse instead of a CNA/LPN.

To submit a request for any of the above health care providers, please fill in the below fields and click "Submit".  We will call you back ASAP.

Request is for a

Patients Name:

Patients Age:

Patients Street Address:   Apt:   City:   State:   Zip:

Hospital Location:   Room #:   Room Phone #:

Reason for Hospitalization:  

Name of Patients Physician:

Name of Individual Responsible for Billing:

Home Phone Number: Please check here if this is the phone number you would like us to call 1st.

2nd Phone Number (cell, etc.): Please check here if this is the phone number you would like us to call 1st.

Relationship to the Patient:

Billing Street Address:   Apt:   City:   State: Zip:

Is there any lifting, pulling, pushing or other individualized physical requirements? 

Are there any specific duties that are being requested or skills needed? 

Are there any other concerns that should be noted that we have not already covered? 

·        We do NOT accept any third party payment – we do NOT bill a patient’s health insurance carrier or Medicare.

·        You will be billed for the private duty services. Payment is expected in the form of a check or cash once the bill is received.

·        We do not accept credit cards for payment – we secure a credit card number only as a guarantee.

·        CMS is insured and fully accredited meeting or exceeding local, state and JCAHO standards and requirements. We provide the best quality health care providers.

·        You do not pay the CMS health care provider directly – we  will pay the health care provider. We request that you not discuss billing or bill rates with the health care provider.

·        You may cancel the health care provider with a minimum of 2 hours notice before the scheduled shift with no financial penalty. A minimum of a 4-hour shift is necessary in order to contract a private duty CMS health care provider.