Referrals

Ensuring everyone has the care they deserve

Referrals

This form can be used to refer a patient to our hospice services. It is essential to fill all the fields. If you would prefer, please fax us all information at (916) 725-2511. Process of this referral will be delayed if there is insufficient supporting evidence.

  • Shortness of breath when the person is at rest or lying down
  • Frequent visits to the emergency room
  • Swelling in hands, arms, legs or feet
  • Dizziness, increased weakness or chest pain when resting

Note: Although we can evaluate whether a patient may need specialized hospice care, only a licensed physician can certify a patient for hospice care.