Hospice Referral Intake Form: Crossroads Hospice & Palliative Referrals

Your top priority is your patient’s well-being. Ours is, too. At Crossroads Hospice & Palliative Care, we’ve spent over 25 years providing compassionate care to improve the quality of life for seriously ill and terminally ill patients. Our mission is to enhance comfort, manage symptoms, and celebrate the time that remains for those nearing the end of life.

If you believe a patient could benefit from our hospice or palliative care services, starting a hospice referral is easy. Our hospice referral intake form streamlines the process, ensuring quick and efficient care for your patient. Crossroads is available 24/7/365, including holidays, so you can make a referral whenever you need to.

Start the patient referral process now.

Referrer Information

First Name

Last Name

Phone

Patient Information

Patient's First Name

Patient's Last Name

Situation / Comments

What does a hospice referral mean?

A hospice referral means that a healthcare provider has recommended hospice care for a patient who is facing a terminal illness, typically with a life expectancy of six months or less. The referral initiates the process of transitioning the patient from curative treatments to a focus on comfort, symptom management, and quality of life. Hospice care is provided by a specialized team that addresses the physical, emotional, and spiritual needs of the patient, ensuring they can spend their remaining time in peace, surrounded by loved ones.

How do you get referred to a hospice?

Getting referred to hospice care typically begins with a discussion between the patient, their family, and a healthcare provider. If the patient has a terminal illness with a life expectancy of six months or less, and they are no longer seeking curative treatment, the doctor may recommend hospice care. The healthcare provider will then complete a hospice referral form to initiate the process. From there, the hospice team will arrange a visit to assess the patient’s needs, explain the care plan, and begin providing support. Families can also directly contact a hospice provider, like Crossroads Hospice & Palliative Care, to inquire about services and start the referral process.

Who decides when a patient goes to hospice?

The decision to enter hospice care is typically made by the patient, their family, and their healthcare provider. It often involves the recommendation of a doctor, who will assess the patient’s condition and determine if they have a terminal illness with a life expectancy of six months or less. While the doctor may initiate the conversation and provide a hospice referral, the final decision rests with the patient and their loved ones. In some cases, families may reach out to a hospice provider directly to discuss options and learn more about how hospice care can provide comfort and support during the end-of-life journey.