Hospice Referral Letter Template: Ensuring Compassionate Care
Introduction: A Vital Transition
Referring a patient to hospice is a significant medical and emotional milestone. The Hospice Referral Letter bridges the gap between curative medicine and palliative support, ensuring the receiving team has all the clinical context needed to provide dignity and comfort immediately.
Why the Referral Letter is Essential
Timely, accurate referrals benefit everyone involved:
- Immediate Symptom Relief: Detailed notes on pain or nausea allow the hospice team to bring the right meds on Day 1.
- Family Support: Alerts the team to family dynamics or caregiver burnout, triggering social work support.
- Reduced Hospitalizations: Smooth transition to home care prevents unnecessary, stressful readmissions to the ER.
- Financial Speed: Complete documentation accelerates insurance authorization, removing financial worry.
Key Components of a Hospice Referral
To ensure rapid admission, include:
- Terminal Diagnosis: The primary condition (e.g., Stage IV Cancer, End-Stage CHF).
- Prognosis Statement: A clear certification that life expectancy is likely < 6 months.
- Functional Decline: Evidence of worsening status (e.g., Palliative Performance Scale score, weight loss).
- Goals of Care: Confirmation that the patient/family understands and chooses palliative focus over curative.
- Current Symptoms: What needs immediate attention (pain, dyspnea, anxiety).
Complete Hospice Referral Template
HOSPICE REFERRAL ORDER & LETTER
Date: [Date]
To: [Hospice Agency Name]
From: [Referring Physician]
Patient: [Name] | DOB: [Date] | Phone: [Number]
Primary Contact: [Name] ([Relationship])
1. Certification of Terminal Illness:
I certify that based on the natural course of the patient's illness, life expectancy is 6 months or less.
* Primary Hospice Diagnosis: Metastatic Pancreatic Cancer (C25.9)
* Secondary Diagnoses: Type 2 Diabetes, Hypertension.
2. Clinical Summary / Evidence of Decline:
Patient has progressive weight loss (>10% in 6 months), decreasing functional status (FAST Score 7a), and is now bedbound >50% of the day. Dependence in 4/6 ADLs. Recent hospitalization for failure to thrive.
3. Current Symptom Management Needs:
* Pain control (current regimen: Morphine ER 15mg BID).
* Nausea management (current regimen: Zofran 4mg Q6H).
* Family requires emotional support and education on end-of-life care.
4. Goals of Care:
Patient and family have decided to forgo further chemotherapy/curative intervention and wish to focus on comfort care at home. DNR/DNI order is in place.
5. Orders:
* Admit to Hospice Care.
* Evaluate and Treat.
* DME: Hospital bed, oxygen, bedside commode.
Physician Signature:
_________________________
[Physician Name, MD/DO]
[NPI Number]Automating Referrals with HealOS
Expedited referral means faster relief for the patient. HealOS AI agents accelerate the administrative steps:
- Prior Authorization Agent: Automatically checks insurance hospice benefits and submits required forms to payers instantly.
- EHR Interoperability Agent: Compiles the "Referral Packet" by pulling relevant history, recent labs, and advance directives from the chart, sending it securely to the hospice agency.
- Clinical Documentation Agent: Helps draft the letter by summarizing evidence of decline (weight logs, functional scores) found in the progress notes.
Automated Workflow Diagram(Mermaid)
graph TD
A[Decision for Hospice] --> B[HealOS Agent Checks Benefit Eligibility];
B --> C[HealOS Aggregates Medical Records];
C --> D[HealOS Drafts Referral Letter];
D --> E[Physician Signs & Certifies Prognosis];
E --> F[HealOS Sends Packet to Hospice Agency];
F --> G[Hospice Agency Contacts Family];
G --> H[Admission Assessment Scheduled];Frequently Asked Questions (FAQs)
Q: What is the main requirement for hospice eligibility?
A physician must certify that the patient has a prognosis of 6 months or less to live if the illness runs its normal course.
Q: Does a referral mean giving up hope?
No, it means redefining hope—shifting focus from cure to comfort, dignity, and quality of remaining life.
Q: Who can initiate a hospice referral?
A doctor usually signs the order, but referrals can be started by nurses, social workers, family members, or the patient themselves.
Q: Can patients leave hospice?
Yes, patients can revoke hospice care at any time to resume curative treatment, and they can be discharged if their condition unexpectedly improves.
Q: What information helps the hospice team most?
Clear details on symptom burden (pain, breathlessness) and the patient's specific goals of care (e.g., 'wants to die at home').
Q: Is the letter enough to admit a patient?
Usually, the hospice agency will also need to perform their own admission assessment to confirm eligibility.
Q: Does insurance cover hospice?
Yes, Medicare (Part A), Medicaid, and most private insurers cover hospice, often at 100% with no copay for the patient.
Q: What if the patient lives longer than 6 months?
They can remain on hospice as long as a physician recertifies that they are still terminally ill with a limited prognosis.
Q: How do HealOS agents assist?
They streamline the paperwork—gathering history, verifying insurance, and sending the referral packet—so care can start immediately.
Q: Does hospice provide 24/7 care?
Hospice provides intermittent visits and 24/7 tele-support. Continuous bedside care is usually only provided during periods of acute crisis.
Compassion Through Efficiency
When time is short, delays are unacceptable. Let HealOS AI agents handle the paperwork so you can focus on comforting the patient and family during this transition.
Example Referral Template
