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Contains four essential forms for admission to hospice care
Change of Patient’s Attending Physician
Live-Alone Agreement
Identification of Payer Sources Also in Admissions package
Election of BenefitsAlso in Admissions package
Change of Designated Hospice
Discharge Notification
Insurance Responsibility Notification Also in Admissions package
Request for Access to Protected Health InformationAlso in Admissions package
Attention Hospice Patients and Families:
Please help us assure that your loved ones’ wishes for treatment are known by all members of their healthcare team.
Click on the link below, print the form and fill out by hand.
Form can be given to any Tranquil Care team member.
Physician Orders for Life-Sustaining Treatment (POLST) Download this PDF (this form is not interactive)