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Patient Volunteer Application 452 N. Switzer Canyon Drive, Ste. A Flagstaff, Arizona 86001 phone: (928) 7791227 faxes: (928) 7795884 www.northlandhospice.orgLast name: ___ First: ___ MI: ___ Address:
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Gather all necessary contact information for the palliative care service provider, including phone number, email address, and location.
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Reach out to the palliative care service provider via phone or email to inquire about their services and availability.
03
Schedule a consultation with the palliative care service provider to discuss your needs and gather more information about their offerings.
04
Fill out any necessary forms or paperwork provided by the palliative care service provider to officially enroll in their services.
05
Stay in regular communication with the palliative care service provider to ensure your needs are being met and to address any concerns that may arise.

Who needs contact palliative care services?

01
Individuals with serious illnesses or conditions that require specialized care and support to manage their symptoms and improve their quality of life.
02
Patients who are receiving end-of-life care and need assistance with pain management, emotional support, and advance care planning.
03
Family members and caregivers of individuals receiving palliative care services who require education, training, and respite care to help them better support their loved ones.
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Contact palliative care services provide support and care for individuals with serious illnesses to improve their quality of life.
Healthcare providers, caregivers, and patients may all be required to file contact palliative care services.
Contact palliative care services can be filled out by providing information about the patient's condition, treatment plan, and goals of care.
The purpose of contact palliative care services is to improve the quality of life for individuals with serious illnesses through comprehensive care and support.
Information such as the patient's medical history, current symptoms, treatment options, and preferences for care must be reported on contact palliative care services.
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