Referrals

Referrals may be made to Hospice of West Alabama by anyone at any time by phone, fax, or online. Once a referral is received, we will contact the doctor for medical history, diagnosis, prognosis, and order for hospice care. Then, someone from our clinical staff will schedule a time to visit the patient/family to get more information and talk about services. After a patient is admitted, we will begin developing a plan of care based on the nursing and social work assessments.

Options For Making A Referral

Make a Hospice Referral

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REFERRAL DETAILS

Patient's Name*

First Last

Patient's Date of Birth

Primary Caregiver's Name*

First Last

Phone Number*

REFERRAL SOURCE

Physician's Name

First Last

Contact Person*

Who can we contact if we have questions?

First Last

Phone Number*

ADDITIONAL INFO

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Talking To Patients About Hospice

Be prepared by confirming medical facts and providing an appropriate environment.
Determine (in advance) how the patient and family want to receive information.
Establish what the patient and family know about their condition by using open-ended questions.
Deliver the information in a straightforward manner.
Respond to emotions of the patient and family.
Establish goals for care and treatment options when possible.
Formulate an overall plan with the patient.
Provide resources that allow them to make an informed decision, like medicare.gov/care-compare

View the benefits of early referral here.