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Hospice Agency Name: Medical ID# Address: Phone Number: () Notification of Hospice Election/Revocation Member Name:Date of Birth:Social Security Number:Name of Residence:Services elected:Hospice Provider:Effective
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What is notification of hospice election revocation?
Notification of hospice election revocation is a form that informs Medicare of a patient's decision to revoke their hospice election.
Who is required to file notification of hospice election revocation?
The hospice provider is required to file the notification of hospice election revocation.
How to fill out notification of hospice election revocation?
The notification of hospice election revocation can be filled out by providing the necessary patient information and reason for revocation.
What is the purpose of notification of hospice election revocation?
The purpose of notification of hospice election revocation is to ensure Medicare is aware of the patient's decision to revoke their hospice election.
What information must be reported on notification of hospice election revocation?
The notification of hospice election revocation must include the patient's name, Medicare number, date of revocation, and reason for revocation.
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