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Coming Home Hospice115 Diamond Street, San Francisco, CA 94114 (415) 8611110 FAX: (415) 8615763 Dear Referral Source, Please review and complete the following application for admission to Coming Home.

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How to fill out the Coming Home Hospice Application online

Filling out the Coming Home Hospice Application online is a straightforward process that allows individuals to apply for hospice services easily. This guide provides clear, step-by-step instructions to help users complete the application accurately and efficiently.

Follow the steps to complete your application online.

  1. Click ‘Get Form’ button to access the application and open it in the editor.
  2. Start by providing the client information, including their full name, social security number, and current contact details. Make sure to check the box if immediate placement is required.
  3. Complete the demographic section, selecting the appropriate gender, ethnicity, and primary language, along with the client's date of birth and age.
  4. Detail the medical history by listing all relevant diagnoses, surgeries, current infusions, and any psychological or substance abuse history applicable to the client.
  5. Fill out the healthcare providers section, including information about the primary and secondary physicians, as well as any psychiatrists or therapists involved in the client’s care.
  6. Provide insurance information, including Medicare or Medi-Cal numbers and details for any private insurance plans. Be sure to include emergency contact information.
  7. Attach copies of necessary legal documents such as Durable Powers of Attorney for Health Care and Finances to ensure that proper care decisions can be made.
  8. Complete the personal and family contacts section, detailing their names and relationships to the patient.
  9. Review all completed fields for accuracy, making sure all required sections are filled in. Make any necessary changes.
  10. Once reviewed, save your changes, download the completed application, print it, or share it as needed.

Start your application process online today to access the supportive services offered by Coming Home Hospice.

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Hospice care includes palliative care to relieve symptoms and give social, emotional, and spiritual support. For patients receiving in-home hospice care, the hospice nurses make regular visits and are always available by phone 24 hours a day, 7 days a week.

If you receive hospice care and live longer than 6 months, you can continue to get hospice care as long as you still meet the Medicare requirements. The information below tells you more about Medicare, Medicaid, and private insurance payments for hospice.

Visit lengths vary according to the patient and family needs. Most patients are initially seen by a nurse two to three times per week, but visits may become more or less frequent based on the needs of the patient and family. Visits are approximately 60 minutes long.

Hospice is a program of care and support for people who are terminally ill (with a life expectancy of 6 months or less, if the illness runs its normal course) and their families. ... Services typically include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions.

Yes, you might be surprised to learn that patients often are discharged from hospice. If their condition improves, treatment can be resumed. Patients must be given less than six months to live, so if their life expectancy changes to beyond six months, they will no longer be eligible for hospice care.

Begin Hospice Care You or your loved one may call a local hospice and request services. The hospice staff will then contact your physician to determine if a referral to hospice is appropriate. Another way to inquire about hospice is to talk with your physician, and he or she can make a referral to hospice.

Intermittent Home Care. Intermittent home care refers to routine care delivered through regularly scheduled visits. ... Continuous Care. Hospice may also provide home nursing for hours at a time, and even overnight. ... Inpatient Respite. ... General Inpatient Care.

Hospice eligibility under Medicare requires that an individual is entitled to Medicare Part A and a doctor determines life expectancy is six months or less, if the terminal illness runs its normal course. Patients must forgo treatment for their terminal illness, but may continue all other medical treatments.

This can be in a house, a long-term care facility, assisted living or retirement community, rest homes, or hospitals. Depending on each patient's needs, the hospice team can visit anywhere from once per day to a couple times a month.

When determining eligibility for hospice, a doctor must certify that the patient is terminally ill, with a life expectancy of six months or less if the disease runs its expected course. The hospice medical director must agree with the doctor's assessment.

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