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COMMUNITY HOSPICE PALLIATIVE CARE SERVICES COMMON REFERRAL FORM Please indicate service type and provider. (Tick one provider only.) HOME CARE IN-PATIENT CARE Assisi Hospice Bright Vision Hospital*
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How to fill out community hospice palliative care

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How to fill out community hospice palliative care:

01
Gather necessary documents: Start by collecting all the relevant medical documents such as medical history, test results, diagnoses, advance directives, and medication lists. These documents will help healthcare professionals assess the patient's condition and provide appropriate care.
02
Identify the patient's goals and preferences: It is important to understand the patient's wishes and preferences regarding their end-of-life care. Discuss their goals, values, and any specific concerns they may have. This information will guide the care team in developing a personalized care plan.
03
Contact a community hospice palliative care provider: Reach out to a community hospice palliative care provider in your area. They can provide guidance on how to proceed further and may assist in the enrollment process. The provider will likely require basic information about the patient, including their demographics, insurance details, and medical history.
04
Assessment and consultation: Once connected with a community hospice palliative care provider, the patient will typically undergo an assessment and consultation. This may involve a visit from healthcare professionals who will assess the patient's physical, emotional, and social needs. They will also discuss the potential services and support provided by the community hospice palliative care program.
05
Create a care plan: Based on the assessment and consultation, a comprehensive care plan will be developed. This plan will outline the goals of care, specific interventions, medication management, symptom control, emotional support, and any other necessary considerations. The care plan is typically customized to meet the patient's unique needs, ensuring their comfort and dignity throughout their journey.
06
Regular communication and updates: Once the patient is enrolled in community hospice palliative care, ongoing communication and updates with the care team are crucial. Regular meetings or virtual check-ins with the healthcare professionals can help address any changing needs, adjust the care plan if necessary, and provide guidance and emotional support to both the patient and their loved ones.

Who needs community hospice palliative care?

01
Patients with life-limiting illnesses: Community hospice palliative care is specifically designed for individuals with serious illnesses that may not be curable. Examples include cancer, heart disease, chronic respiratory diseases, neurodegenerative conditions, and advanced dementia.
02
Patients seeking comfort-focused care: Community hospice palliative care is centered around improving the patient's quality of life. It aims to manage pain, symptoms, and emotional distress while providing holistic support to enhance the overall well-being of the patient and their family.
03
Individuals desiring to remain at home: Many people prefer to receive end-of-life care in the comfort of their own homes, surrounded by their loved ones. Community hospice palliative care can help facilitate this by providing necessary medical equipment, specialized healthcare professionals, and other support services to enable patients to remain at home for as long as possible.
04
Caregivers seeking assistance: Community hospice palliative care also provides much-needed support for caregivers. The care team can offer respite care, emotional counseling, education about the patient's condition, and assistance with navigating through complex medical decisions. This support system helps alleviate caregivers' burdens and ensures they can provide the best possible care for their loved ones.
Note: It is important to consult with healthcare professionals and community hospice palliative care providers for accurate and comprehensive guidance tailored to your specific situation.
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Community hospice palliative care is a specialized care for individuals facing life-limiting illnesses or conditions, focusing on improving quality of life and providing comfort.
Healthcare providers, hospice facilities, and healthcare organizations are required to file community hospice palliative care.
Community hospice palliative care can be filled out by healthcare professionals with the necessary patient information, treatment plans, and care provided.
The purpose of community hospice palliative care is to provide compassionate care, pain management, and emotional support to individuals with life-limiting illnesses or conditions.
Information such as patient demographics, medical history, treatment plans, pain assessments, and care provided must be reported on community hospice palliative care.
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