Provider Forms

At East House we serve individuals with persistent mental health and substance use disorders with the goal of empowering them to recover and to live healthy and fulfilling lives. Through a network of services, which includes supported housing and care coordination as well as education and employment programs, East House treats the whole person and helps move individuals from illness to health.

If your patient is interested and would benefit from East House programs and services, your referral is appreciated.

To make an individual’s residential application process easier, please have them complete this consent form for individuals (therapist, doctors, family, counselors, treatment centers) they would like to have included in their admissions process.

Please note: All eligible applicants will have financial case management coordination as part of their referral intake process to identify funding sources.

East House Canal Commons

Now accepting applications for East House program units at Canal Commons. For this program, a Canal Commons Referral Form, Canal Commons Application Package, and ESSHI 2 Homeless Verification Form must be completed. View the Canal Commons page to learn more and get started.

Once the Canal Commons Referral Form and ESSHI-2 Homeless Verification form has been submitted, processed and approved by the East House Admissions Team, the individual will need to complete and submit the following paperwork:

East House Mental Health Programs

For East House’s mental health programs, a Monroe County’s Single Point of Access (SPOA) application must be completed. All referrals to the East House mental health program are submitted by mental health providers through the Single Point of Access (SPOA) application.

View the Physician Authorization for Restorative Services.

East House Substance Use Disorder Programs

For East House’s substance use disorder programs, a Monroe County Office of Alcoholism and Substance Abuse Services (OASAS) Residential Services application must be completed.

  • Thank you for your interest in the East House’s Substance Use Disorder Residential Program. For an applicant to be eligible for this program, they must complete the OASAS Application for Residential Services (above) and submit with the following documentation:

    • Most recent psychosocial/evaluation for substance use and mental health disorders with DSM diagnoses

    • Most recent history and physical in the past 12 months

    • Most recent laboratory results including complete blood count and differential, routine and microscopic urinalysis, and urine screen for drugs within the past 12 months

    • Most recent TB (Tuberculosis) screening (PPD or Chest x-ray) within the past 12 months

    • Consent for Release of Information between current Service Provider and Residential Provider (NOTE: The referring outpatient/inpatient therapist must make the request for residential services in ARES when the person is pending/receiving DHS temporary assistance.)

    These documents may be sent to East House Admissions Team, 259 Monroe Avenue, Suite 200, Rochester, NY 14607 or faxed to 585-238-8998. Please call the Admissions team at 585-238-4800 with questions.

    Once the OASAS application, Consent form, Psychosocial and PPD are received, a phone screen will be scheduled. While the individual is being evaluated for services, the remaining documentation will be contained when applicable. After a phone screen is completed, eligibility and program recommendations will occur and the individual will be scheduled for a program visit if eligibility is met. Once the individual completes a program visit, they must attend a weekly wait list group until a bed becomes available.

  • Thank you for your interest in the East House’s Substance Use Disorder Apartment Program. For an applicant to be eligible for this program, they must complete the OASAS Application for Residential Services (above) and submit with the following documentation:

    • Most recent psychosocial/evaluation for substance use and mental health disorders with DSM diagnoses

    • Most recent history and physical in the past 12 months

    • Most recent laboratory results including complete blood count and differential, routine and microscopic urinalysis, and urine screen for drugs within the past 12 months

    • Most recent TB (Tuberculosis) screening (PPD or Chest x-ray) within the past 12 months

    • Consent for Release of Information between current Service Provider and Residential Provider (NOTE: The referring outpatient/inpatient therapist must make the request for residential services in ARES when the person is pending/receiving DHS temporary assistance.)

    These documents may be sent to East House Admissions Team, 259 Monroe Avenue, Suite 200, Rochester, NY 14607 or faxed to 585-238-8998. Please call the Admissions team at 585-238-4800 with questions.

    All documents are required prior to an intake. After completion of intake, if there is not an immediate opening, information about apartment availability will be communicated.

Supportive Housing Services

If an individual might benefit from East House’s supportive housing services, please review eligibility and documentation requirements. Please note:

  • Thank you for your interest in the East House Permanent Supportive Housing Program. For an applicant to be eligible for this program, they must:

    • Have a primary diagnosis of a substance use disorder

    • Have active enrollment in Medicaid

    • Have a history of 2 inpatient hospitalizations or 5 emergency room visits within the past 12 months (or 1 inpatient and 4 emergency room visits, prior to entering treatment)

    • Be a single adult

    • Have a history of, or is at risk of, homelessness

    The following documents are needed for consideration for admission into the program:

    • Bank statements (if applicable)

    • Budget Sheet from DHS (if applicable, and no older than 30 days)

    • Copy of Current Award Letter from SSA (if applicable)

    • Copy of Medicaid Card

    • Current Psychosocial history including chemical dependency diagnosis from chemical dependency provider

    • Permanent Supportive Housing Consent form

    • Permanent Supportive Housing Referral Form

    • Written documentation of hospitalizations and/or emergency room visits

    • Written verification of homelessness from shelters or verification of imminent homelessness

    Please call the Admissions team at 585-238-4800 with questions.

  • All Independent Living Program referrals are submitted by mental health providers by completing the Single Point of Access (SPOA) Application.

    View the Physician Authorization for Restorative Services.

Questions? Please contact the East House Admissions Team at 585-238-4800 or admissions@easthouse.org