Patient Referral

Is Hospice For You?
(Answer the following questions with a yes or no.)

 

• Been hospitalized or gone to the emergency room    several times in the past six months?

Been making more frequent phone calls to your    physicians?

Started taking medication to lessen physical pain?

Started spending most of the day in a chair or bed?

Fallen several times over the past six months?

Started needing help from others with:
Bathing
Dressing
Eating
Getting out of bed
Walking


Started feeling weak or more tired


Experienced weight loss making clothes noticeably    looser?


Noticed a shortness of breath, even while resting?

Been told by a doctor that life expectancy is limited?

 

If you answered yes to  3 or more and would like to talk to someone about the specifics of what is going on with you or a loved one, please call or contact us today.

 

Referral Process
You believe that hospice can help you and your family, just ask.


A doctor will have to make the final approval, but you have now begun the process. How you proceed from here is up to you.

 

1. You can ask your doctor to make the referral. Most doctors support their patient’s involvement with hospice care. Each patient need is unique and your doctor will help you to gain the full benefit of hospice services. Ultimately you have the decision as to when to begin care.

 

2. We want to make it easy as possible for you, so we’re here to help in the referral process. You or your loved one are invited to call us and we’ll contact your physician to determine if a referral to hospice is appropriate. You can also fill out the referral form below which will be sent to our Referral Team and we will call you.

 

Once the referral is made our hospice team will give you a call to set up an initial meeting. During this meeting we’ll talk with you about our services, your needs and how hospice can help. Because everything about hospice is a choice, we’ll also speak with you about your wishes for the type of care you want. You and your physician will remain active participants in your plan of care.

 

 


 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Administrative Office
Phone: 704.487.4677
Fax: 704.481.8050
Wendover Hospice House
704-487-7018
Testa Family Hospice House
Phone: 704-751-3918