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340 College Street, Suite 410, Toronto, Ontario M5T 3A9 Tel: 4169623202 Fax: 4169629653 Web: www.kensingtonhealth.org Submission Instructions: After completing the form, kindly submit it to the following
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How to fill out day hospice program referral

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How to fill out day hospice program referral

01
To fill out a day hospice program referral, follow these steps:
02
Obtain the referral form from the day hospice program or download it from their website.
03
Fill out the patient's personal information, including their name, date of birth, address, and contact details.
04
Provide the patient's medical history, including any relevant diagnoses, current medications, and previous treatments or procedures.
05
Include information about the patient's primary healthcare provider or referring physician, including their name, contact information, and any specific instructions or preferences for the referral.
06
Specify the reason for the referral to the day hospice program, such as the need for pain management, symptom control, emotional support, or end-of-life care.
07
Include any additional relevant information, such as the patient's preferences, goals of care, or specific needs that should be addressed by the day hospice program.
08
Review the completed referral form for accuracy and completeness.
09
Submit the referral form to the day hospice program via mail, fax, email, or any other designated method specified by the program.
10
Follow up with the day hospice program to ensure they have received the referral and to inquire about the next steps or any additional information they may require.
11
Keep a copy of the referral form for your records.

Who needs day hospice program referral?

01
Anyone who requires specialized care, support, or services provided by a day hospice program may need a day hospice program referral.
02
This may include individuals with a life-limiting illness or condition, such as cancer, advanced heart disease, neurodegenerative disorders, or end-stage organ failure.
03
Patients who experience significant physical symptoms, emotional distress, or require skilled nursing care, pain management, or palliative care may also benefit from a day hospice program referral.
04
The decision to pursue a day hospice program referral may be made by the patient, their family members, primary healthcare providers, specialists, or other healthcare professionals involved in the patient's care.
05
It is important to consult with the day hospice program or healthcare professionals to determine the specific eligibility criteria and requirements for a day hospice program referral.

What is Day Hospice Program Referral Individual's ination Form?

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Template Day Hospice Program Referral Individual's ination instructions

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A day hospice program referral is a request for admission to a day hospice program, which provides patients with specialized care during the day while allowing them to return home at night.
Healthcare professionals, such as doctors or case managers, are typically required to file a day hospice program referral on behalf of eligible patients.
To fill out a day hospice program referral, one must provide patient information, medical history, current treatment details, and specific care needs in the referral form.
The purpose of a day hospice program referral is to initiate access to necessary hospice services for patients who need support during the day for symptom management and emotional support.
Mandatory information on a day hospice program referral includes patient identification details, diagnosis, caregiver information, and the reason for referral.
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