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Get VA Hospice Of The Piedmont Guideline Worksheet For Determining Terminal Prognosis 2009-2024

ID# Certification Date: The following criteria will support a prognosis of six months or less if the terminal illness runs its normal course for patients with Decline in Clinical Status on initial certification. Since determination of decline presumes assessment of a patient s status over time, it is essential that both baseline and follow-up determinations be reported where appropriate. Baseline data may be established on admis.

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