God’s Love We Deliver - Client Referral Packet - Medical Nutrition Therapy and Meal Delivery Service

Sep 27, 2026

Client Referral Packet for God’s Love We Deliver, a non-profit providing medically tailored, home-delivered meals for people living with serious illnesses who face physical limitations that make shopping and cooking difficult. The packet explains eligibility requirements, form completion steps, and how medical professionals and prospective clients submit referral, medical, HIPAA, policy, and—when applicable—HIV/AIDS documentation. After intake, the organization contacts applicants by telephone and sends welcome and, for HIV/AIDS, grievance materials.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Referral process

Forms required

HIPAA authorization

Additional HIV/AIDS information

Policies and procedures

Health proxy or power of attorney

What to do once forms are complete

Intake follow-up and eligibility

Client Referral Packet God’s Love We Deliver is a non-profit organization that provides nutritious, high-quality meals for people living with serious illnesses who, because of their medical diagnoses, have physical limitations making it difficult to shop and cook for themselves. Applicants must have a consistent address to receive deliveries and access to kitchen amenities (refrigerator, freezer, and oven or microwave) to store and heat food. If you are interested in receiving the home-delivered medically tailored meal service from God’s Love We Deliver or you are a professional who would like to refer a client, then please complete the following documents: 1. The Referral Form and Medical Form Page one of this form can be filled out by a professional, prospective client, or a family member. Page two of this form requires a licensed medical doctor or nurse practitioner to input medical information and provide a signature. To meet the God’s Love We Deliver eligibility requirements, the applicant must have a qualifying medical diagnosis and Activities of Daily Living (ADL) limitations (trouble shopping or cooking) . For individuals with a diagnoses of dementia or dementia related to HIV/AIDS, we will consider cognitive limitations caused by their diagnoses in lieu of or addition to ADL limitations. 2. The Health Information, Portability and Accountability Act (HIPAA) Form To maintain confidentiality, the applicant can permit communication between specific people or entities and God’s Love We Deliver about their medical condition and service. Examples of entities on the HIPAA Form include doctors, hospitals, clinics, social workers, family members, or friends. 3. If the applicant’s diagnosis is HIV/AIDS, then we request additional information: • Proof of Income: Public Benefit card, Social Security Insurance (SSI) letter, budget letter, AIDS Drug Assistance Program (ADAP) letter, or ePACES. • Proof of Residency: Recent utility bill, phone bill, residency letter, SSI letter, State ID, or ePACES. 4. Policies and Procedures Form: client should return a signed copy to God’s Love 5. If the client is living with dementia, we will need a Health Proxy or Power of Attorney to designate the prospective client’s caretaker. God’s Love We Deliver staff can provide this, if needed. What to do once forms are complete Once all forms have been completed and signed, please send the complete packet of documents by fax, email, or postal mail: Fax: (212) 294-8198 Email: [clients@glwd.org](clients@glwd.org) Postal mail: Client Services Department c/o God’s Love We Deliver 166 Avenue of the Americas, NY, NY 10013 More information about the intake process Our goal is to respond to the completed application as quickly as possible. If you, or your client, would like to follow up on the status of your application, then please call our Client Services team at 212-294-8102 or email [us at](us at clients@glwd.org)[ ](us at clients@glwd.org)[clients@glwd.org](us at clients@glwd.org). After receiving the applicant’s documents, God’s Love We Deliver will contact the individual for an intake by telephone. Eligibility for admission to our program is subject to approval by God’s Love We Deliver. If the prospective client does not meet our eligibility criteria, we will refer you to one of our affiliate partners, as we are able. Given the specific mission of God’s Love We Deliver, we do not serve individuals with the following situations/diagnoses if they do not have a qualifying diagnosis and ADL limitation: • Poverty • Chronic illness with no physical limitation • Injuries (example: broken wrist) • Mental Illness • Age-related frailties • Congenital disease or a physical syndrome that an individual has had since birth • Not able to cook for themselves After God’s Love intakes a new client, we will send the client a Welcome Packet with more program information. • If the client is living with HIV/AIDS, we

FAQs

Who can complete the referral and medical forms, and what are the requirements for medical sign-off?

Page one can be completed by a professional, prospective client, or a family member. Page two requires a licensed medical doctor or nurse practitioner to enter medical information and provide a signature.

What information is requested on the HIPAA form?

The applicant can permit communication between specific people or entities and God’s Love We Deliver about the medical condition and service. The form may include doctors, hospitals, clinics, social workers, family members, or friends.

What extra documents are required if the client’s diagnosis is HIV/AIDS?

Additional information includes proof of income (such as Public Benefit card, SSI letter, budget letter, ADAP letter, or ePACES) and proof of residency (such as recent utility or phone bill, residency letter, SSI letter, State ID, or ePACES).

Sep 27, 2026

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