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August 29, 2019Dear Provider, Superior Healthily is committed to partnering with providers to promote quality health care and maximize the health status of our members. We've been notified that the

How to fill out hospice election statement changes

How to fill out hospice election statement changes

1. To fill out hospice election statement changes, follow these steps:
2. Obtain the hospice election statement form from the hospice provider or download it from their website.
3. Read the instructions carefully to understand the purpose and requirements of the form.
4. Fill in the patient's personal information such as name, address, date of birth, and Medicare number.
5. Provide details about the hospice provider, including their name, address, and contact information.
6. Indicate the date of election for hospice care and the effective date.
7. Specify the attending physician and the medical director of the hospice program.
8. Sign and date the statement to acknowledge your decision and understanding of the election.
9. If applicable, include the signature of the patient representative or legal guardian.
10. Review the completed form for accuracy and completeness before submitting it to the hospice provider.
11. Keep a copy of the filled-out hospice election statement for your records.

Who needs hospice election statement changes?

1. Anyone who wishes to elect hospice care for themselves or on behalf of a loved one needs to fill out a hospice election statement.
2. This includes individuals who have been diagnosed with a terminal illness and want to receive hospice services.
3. Family members or legal representatives who have the authority to make healthcare decisions for a patient can also complete the statement.

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What is hospice election statement changes?

Hospice election statement changes refer to updates or modifications made to the initial hospice election statement by a patient who has elected to receive hospice care.

Who is required to file hospice election statement changes?

The patient or their authorized representative is required to file hospice election statement changes.

How to fill out hospice election statement changes?

Hospice election statement changes can be filled out by providing the updated information and submitting it to the hospice care provider.

What is the purpose of hospice election statement changes?

The purpose of hospice election statement changes is to ensure that the patient's preferences and needs are accurately reflected in their hospice care plan.

What information must be reported on hospice election statement changes?

Hospice election statement changes must include any updates to the patient’s personal information, contact details, medical condition, and preferences for care.