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Tranquil Care’s form downloading is a secure process which requires you
to have access to email to receive your temporary security code.

All forms are for single use. For additional copies, simply download again.

admissions
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Contains four essential forms for admission to hospice care

individual_forms
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Change of Patient’s
Attending Physician

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Live-Alone Agreement

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Identification of Payer Sources
Also in Admissions package

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Election of Benefits
Also in Admissions package

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Change of Designated Hospice

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Discharge Notification

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Insurance Responsibility Notification
Also in Admissions package

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Request for Access to
Protected Health Information
Also 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.

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Physician Orders for
Life-Sustaining Treatment (POLST)
Download this PDF
(this form is not interactive)