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How to Refer a Patient
This section is designed to give health professionals quick information about how to refer a patient to Evercare Hospice & Palliative Care, key clinical indicators for hospice care, what services we cover and guidelines for requesting a wish on behalf of a patient.
What Evercare Hospice & Palliative Care Covers
How to Request a Wish from Dream Foundation
How to Refer a Patient to Evercare Hospice & Palliative Care
Call us at 1-877-273-5534 and we will walk you through the referral process. We respond to all patient-related calls within 15 minutes—24 hours a day, 7 days a week. Unless requested otherwise, patients can begin receiving hospice or palliative care the same day you contact us.
Preparing to Refer a Patient
We make it simple to refer a patient to Evercare Hospice & Palliative Care. These are the main steps you'll be asked to complete:
1. Gather the following documentation for the referral form:
- Doctor’s order for hospice or palliative care (required)
- Legal documents (MDPOA or POA)
- Living will
2. Be prepared to answer the following questions:
- Is the attending physician the person who is requesting hospice?
- Is the patient and/or family aware of the diagnosis and prognosis?
- Do the patient and family desire hospice?
- Can the word “hospice” be used?
- Has the patient received hospice care previously? If yes, what dates of service?
- Is the patient receiving skilled nursing services? With whom have you verified this?
- Have you talked to the patient and/or family about the financial responsibility for room and board if the patient has no Medicaid?
- Does the patient have a living will?
3. Complete the referral form (PDF 142.9 KB).
4. Fax the referral form to the Evercare Hospice & Palliative Care office closest to you (fax numbers are listed on the referral form).
Call us at 1-877-273-5534 anytime—24 hours a day, 7 days a week—if you have questions about the referral process. We’re happy to help.
Key Clinical Indicators for Hospice or Palliative Care
The key clinical indicators for hospice or palliative care include:
- Progressive decline in status despite curative treatments
- Frequent hospitalizations
- Repeat or multiple infections
- Increased or uncontrolled pain
- Progressive/profound weakness and fatigue
- Shortness of breath with or without oxygen
- Dependency (decrease in ADLs)
- Alterations in mental status
- Weight loss
Hospice has been demonstrated to improve the quality of life for patients with life-limiting conditions and disease, including:
- Cancer
- Cardiovascular disease
- Congestive heart disease
- Chronic obstructive pulmonary disease (COPD)
- Dementia or Alzheimer’s disease
- Neurological disease (e.g., Parkinson’s, ALS)
- Renal disease
- Liver disease
- Acquired Immune Deficiency Syndrome (AIDS/HIV)
For more information on evidence-based practices that are accepted medical indicators for hospice eligibility, download Evercare Hospice & Palliative Care’s comprehensive publication Hospice Indicators (PDF 147.1 KB).
What Evercare Hospice & Palliative Care Covers
We not only provide all of the basic hospice and palliative care services required by law; we offer many additional services that standard hospices do not. Here are the benefits and services our patients could receive:
- Involvement of an Evercare Hospice or Palliative Care Physician
- Unrestricted access to the kind of therapies patients need (including certain life-prolonging therapies, like radiation or chemotherapy)
- Coordinated care with the patient’s physician
- Assistance navigating the health care system and Medicare/Medicaid certification
- 24-hour-a-day on-call support
- Pain management and control
- Psychological and spiritual support
- Family support and education
Evercare Hospice & Palliative Care is Medicare-certified, which means that our services are covered by Medicare, Medicaid, military health plans and most private insurance companies. Any health care plan member is eligible for Evercare Hospice & Palliative Care. A patient does not have to be a member of a UnitedHealth Group or Evercare plan to qualify to receive our services.
How to Request a Wish from Dream Foundation
Dream Foundation is the first and largest national nonprofit wish-granting organization for adults with life-limiting illness. Dream Foundation has been designated as one of the recipient organizations of donations received by Evercare Hospice & Palliative Care, and at least one of Evercare's patients was fortunate to have been granted a wish.
If you’d like to request a wish on behalf of patient, please visit Dream Foundation and follow the instructions for hospice professionals near the bottom of the page. Note that wishes must be requested by hospice professionals; they cannot be requested by friends or family members of patients.
Where to Find Us
We offer hospice services in several states from New England to the Southwest. Please select your state from the dropdown below to see if Evercare Hospice & Palliative Care is available in your area.
We′re Here to Help
Call 1-877-273-5534 TTY: 71124 hours a day, 7 days a week
Speak with an Evercare Hospice & Palliative Care representative to discuss your needs, or let us contact you.
How You Can Help
Learn how to become a volunteer member of our hospice and palliative care team.
Make a Donation
Evercare (TM) Hospice and Palliative Care is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, sex, religion, color, age, national origin, disability, sexual orientation or other protected factor. Evercare TM Hospice and Palliative Care is offered by Evercare Hospice, Inc.
©2010 UnitedHealthcare Services, Inc.
