CERTIFICATION OF TERMINAL ILLNESS 2025

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I certify that is terminally ill with a life expectancy of six months or less if the terminal illness runs its normal course. I have discussed with patient and/or family, and all are in agreement with transferring care to Hospice del Valle, Inc., Medical Director.
A statement that the patient is terminally ill with a life expectancy of 6 months or less if the terminal illness runs its normal course; - Example: I certify that (beneficiarys name) is terminally ill with a life expectancy of six months or less if the terminal illness runs its normal course.
All hospice care and services offered to patients and their families must follow an individualized written plan of care (POC) that meets the patients needs. The hospice interdisciplinary group establishes the POC together with the attending physician (if any), the patient or representative, and the primary caregiver.
Patient-designated attending physician (if they have one) who certifies their terminal condition. The attending physician must meet the definition of physician specified in 42 CFR 410.20(b). Under 42 CFR 418.22(c), these two categories of physicians must initially certify the patients terminal condition.
Documentation of Physician Certification of Terminal Illness (CTI) The Initial Certification is the first 90-day period of hospice coverage. For Medicare payment, the initial certification must contain two physician signatures if the beneficiary has designated an attending physician.
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