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LES BURGS HOSPICE REFERRAL FORM TEL NO. 251111 FAX NO. 251027 EMAIL: nurses Leesburg.comNAMEDOBADDRESSPOSTCODE NEXT OF KIN (name and contact number)NOK INFORMED?GPSURGERYPATIENT LOCATION DIAGNOSIS
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Step 1: Obtain a copy of the Les Bourgs Hospice admission form.
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Step 2: Fill out your personal information such as your name, address, phone number, and date of birth.
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Step 3: Provide information about your next of kin or emergency contact.
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Step 4: Indicate any relevant medical history, current medications, and allergies.
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Step 5: Provide details about your preferred care options, such as respite or end-of-life care.
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Step 6: Sign and date the form.
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Step 7: Submit the completed form to Les Bourgs Hospice for review and processing.

Who needs les bourgs hospice?

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Les Bourgs Hospice is for individuals who are in need of palliative and end-of-life care.
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This includes patients with terminal illnesses or those who require specialized medical support and pain management.
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Les Bourgs Hospice also provides respite care for individuals who need temporary relief from caregiving responsibilities.
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Anyone in the community can access the services of Les Bourgs Hospice based on their individual needs and circumstances.
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The hospice strives to offer compassionate care and support to enhance the quality of life for those facing life-limiting illnesses.
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Les Bourgs Hospice is a healthcare institution that provides palliative care and support for individuals with terminal illnesses, focusing on comfort and quality of life.
Individuals who are receiving care from Les Bourgs Hospice or affiliated healthcare professionals need to file necessary documentation related to their treatment and care plans.
To fill out the Les Bourgs Hospice forms, individuals must provide personal medical information, treatment history, and any specific preferences regarding end-of-life care.
The purpose of Les Bourgs Hospice is to provide compassionate care to those in the final stages of life, ensuring they experience dignity and comfort.
The information that must be reported typically includes patient demographics, medical history, treatment plan details, and any relevant wishes regarding end-of-life care.
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