Get Hospice Of The Sierra Intake Fax Form - Adventist Health

Filling out the Hospice Of The Sierra Intake Fax Form is an essential step for accessing necessary end-of-life care services. This guide provides clear, step-by-step instructions to assist you in accurately completing the form and submitting it online.

Follow the steps to successfully complete the intake fax form

1. Click ‘Get Form’ button to retrieve the Hospice Of The Sierra Intake Fax Form and open it in your document editor.
2. Begin with entering the patient’s name in the designated field. Ensure that the spelling is correct to avoid any confusion.
3. Next, input the patient's date of birth (DOB) in the appropriate section, formatted as month/day/year.
4. In the phone number field, provide a reliable contact number for the patient.
5. Indicate the patient's insurance provider in the insurance field to facilitate coverage verification.
6. Complete the referring physician section by writing the name of the physician who is directing the referral.
7. Fill in the primary care physician's name to give an overview of the patient’s ongoing medical care.
8. List the patient’s diagnosis, ensuring to provide accurate details that would aid in their care.
9. If there is a contact person different from the patient, enter their name and phone number in the respective fields.
10. Lastly, make sure to include the most recent clinician's note or history and physical (H+P) document along with a demographics sheet as specified before submission.
11. After completing all sections, review the form for accuracy and completeness. You can then save your changes, download, print, or share the form as needed.

Start completing the Hospice Of The Sierra Intake Fax Form online to ensure timely care for your patients.