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MT HOOD HOSPICE VOLUNTEER APPLICATION Return to: PO Box 1269, Sandy, OR 97055 Name Date Address Phone: Day Birthday: Evening or Age Range: 2040 4070 Over 70 Spouse/Significant Other:(optional) Names

How to fill out mt hood hospice

How to fill out Mt Hood Hospice:

1. Start by obtaining the necessary forms from the Mt Hood Hospice organization. These forms are typically available on their website or can be requested through their office.
2. Fill out the personal information section, including your name, address, contact details, and any relevant identification numbers.
3. Provide information about the patient, including their name, date of birth, and medical history. It is important to be as detailed and accurate as possible to ensure the patient receives appropriate care.
4. Indicate the reason for seeking hospice care and provide any relevant medical documentation or referral letters from healthcare professionals.
5. Include information about the patient's primary caregiver and any additional caregivers involved in their care. This may include their relationship to the patient, contact details, and availability.
6. Provide a list of medications the patient is currently taking, including the dosage and frequency. It is essential to update this information regularly to ensure appropriate medication management.
7. Specify any special instructions or requests regarding the patient's care, such as dietary restrictions, religious preferences, or preferred methods of communication.
8. Review the completed form and ensure all information is accurate and up to date. If any changes or updates occur, inform Mt Hood Hospice as soon as possible.
9. Submit the filled-out form to Mt Hood Hospice through the designated channels, whether it be by mail, fax, or through their online submission portal.

Who needs Mt Hood Hospice:

1. Individuals with a terminal illness who require specialized care and support to manage their symptoms and improve their quality of life.
2. Patients who have been diagnosed with a life-limiting condition and have a prognosis of six months or less, as determined by their healthcare provider.
3. Families and loved ones of patients who would benefit from emotional and psychological support during the end-of-life journey.
4. Individuals seeking assistance with pain management, symptom control, and overall comfort in their final stages of life.
5. Patients who wish to receive care and support in the comfort of their own homes, rather than in a hospital or nursing facility.
6. Individuals who desire a holistic approach to end-of-life care, encompassing physical, emotional, social, and spiritual aspects.

Note: It is important to consult with Mt Hood Hospice or a healthcare professional for specific eligibility criteria and guidelines when considering hospice care.

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