Refer a Patient

Take the Quiz:

Is Palliative Care Right for Your Patient?

Answer these questions to determine if palliative care might be beneficial for your patient. It’s available at any stage of a serious illness, can be combined with curative treatments, and can be provided wherever the patient calls home.

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Is Palliative Care Right for Your Patient?

Answer these questions to determine if palliative care might be beneficial for your patient. It’s available at any stage of a serious illness, can be combined with curative treatments, and can be provided wherever the patient calls home.

1. Does your patient have one or more serious illnesses such as:

  • Cancer
  • Congestive heart failure (CHF)
  • Chronic obstructive pulmonary disease (COPD), emphysema, lung disease
  • Kidney failure
  • Liver failure
  • Neurological diseases (e.g., ALS, Parkinson's)
  • Dementia
Yes
No

2. Is your patient experiencing symptoms that interfere with their quality of life? These symptoms might include:

  • Pain or discomfort
  • Shortness of breath
  • Fatigue
  • Anxiety
  • Depression
  • Lack of appetite
  • Nausea
  • Constipation
  • Fluid build-up
Yes
No

3. Is your patient becoming a hospital “frequent flyer”?

  • Frequent trips to the emergency room
  • Three or more admissions in the past year with the same symptoms
Yes
No

4. Is your patient making frequent calls to your office because they need help with:

  • Controlling symptoms and side effects
  • Coping with the stress of a serious illness
  • Knowing what programs and resources are available
Yes
No

5. Would you be surprised if your patient passed away within the next 12-24 months?

Yes
No

Please select an answer

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