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Get California Hospice Care Waiver Charge Form
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How to fill out the California Hospice Care Waiver Charge Form online
Completing the California Hospice Care Waiver Charge Form online is a straightforward process that requires careful attention to specific sections. This guide will walk you through each part of the form to ensure accurate completion.
Follow the steps to successfully fill out the form online.
- Click ‘Get Form’ button to obtain the California Hospice Care Waiver Charge Form, which will open it in your editor.
- Review the top section of the form, which outlines the purpose of the waiver request. Understand the four criteria available for the waiver, each related to confinement in a hospital, nursing home, or enrollment in a hospice care program.
- Select the appropriate checkbox that applies to your situation. You can choose from the following options: currently confined in a hospital or nursing home, recently discharged from a hospital or nursing home, currently enrolled in hospice care, or recently discharged from hospice care.
- Fill in the facility name where you were confined or enrolled, including the telephone number for that facility, in the designated fields.
- Provide your signature or the signature of your partner, along with the date, in the designated signature field.
- Ensure that the attending physician signs the form in the appropriate location and includes the date.
- Review the completed form for accuracy. Once verified, you can save the changes, download, print, or share the completed document as needed.
Complete your documents online today for a smoother filing experience.
Hospice They get care from a Medicare-certified hospice. Their attending physician (if they have one) and the hospice physician certifies them as terminally ill, with a medical prognosis of 6 months or less to live if the illness runs its normal course.
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