Refer a Charity Patient for Home Visit

We desire to put meaning to quality of life – one patient at a time, for several times. What do you desire that makes you happy? Ours is simply to give help and serve. GOOD KARMA VISITS is an Outreach Program that we do as charity work for the less fortunate individuals in the community. We have nurses that do home visit; vital signs check; morning care; health, safety & risk assessment; and review of medications for the poor patient, sick elderly and chronically ill confined at home for FREE. Home visits are regularly done on Saturdays from 7am-10am.

Refer and support a less fortunate patient in need of nursing care today!

Contact Person (Contact Person of the Patient)


Patient Info

Current Town is requered.
This is required.
Guide Questions :
1. What is the life-long, chronic case and/or diagnosis of the patient?
2. Why should we prioritize this indigent patient for home visit? Ex. Post-hospitalization, HAMA, Terminally-ill, Lost to follow-up, No access to care, etc.
3. What specific care need does the patient need during the home visit? Ex. Bed bath, vital signs check, medications review, health education, etc.
4. What specific landmark do we need to know to find the patient’s location and/or residence?
5. What additional assistance can you give us (if any) to facilitate the home visit?

Refering Person (Your Name and Contact)