Certification of terminal illness form: Fill out & sign online

Here's how it works

01. Edit your certificate of terminal illness online

01. Edit your certification of terminal illness online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send cti form hospice via email, link, or fax. You can also download it, export it or print it out.

The fastest way to redact Certificate of terminal illness template online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is the greatest editor for updating your documents online. Adhere to this straightforward instruction to redact Certificate of terminal illness template in PDF format online for free:

Register and log in. Create a free account, set a secure password, and proceed with email verification to start working on your forms.
Add a document. Click on New Document and choose the form importing option: upload Certificate of terminal illness template from your device, the cloud, or a secure link.
Make changes to the sample. Take advantage of the top and left-side panel tools to redact Certificate of terminal illness template. Add and customize text, images, and fillable fields, whiteout unnecessary details, highlight the significant ones, and comment on your updates.
Get your documentation completed. Send the sample to other people via email, generate a link for quicker file sharing, export the sample to the cloud, or save it on your device in the current version or with Audit Trail added.

Explore all the advantages of our editor right now!

See more certificate of terminal illness template versions

We've got more versions of the certificate of terminal illness template form. Select the right certificate of terminal illness template version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (162 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

What is a CTI for hospice?

The Hospice Medicare CTI Audit Tool allows Hospice providers to audit the certification of terminal illness for all technical requirements. The Hospice Medicare Election Audit Tool allows Hospice providers to audit the Medicare election statement for all technical requirements.

What is the current structure of the hospice benefit periods?

Hospice care is given in benefit periods. You can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. A benefit period starts the day you begin to get hospice care, and it ends when your 90-day or 60-day benefit period ends.

What is 1 role of the attending physician for hospice care?

Once the decision to refer to hospice is made, the family physician typically continues to be the patient's primary attending physician. The attending physician is expected to remain in charge of the patient's care, write orders, see the patient for office visits, and complete and sign the death certificate.

What must be included in or with the physicians narrative as part of an initial hospice certification of terminal disease?

As part of the narrative, the narrative shall include a statement directly above the physician signature attesting that by signing, the physician confirms that he/she composed the narrative based on his/her review of the patient's medical record or, if applicable, his or her examination of the patient.

Who are the members of the hospice interdisciplinary team?

The members of this interdisciplinary team include a physician, nurse, hospice aide, social worker, chaplain, volunteer and bereavement specialist.

hospice recertification tool

form 3074 hospice medicare cti audit tool medicare hospice cti requirements hospice verbal certification requirements who must sign the initial certification of terminal illness form 3074 hospice medicare cti audit tool medicare hospice cti requirements hospice verbal certification requirements who must sign the initial certification of terminal illness

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

What should be captured in the physician's narrative on the certification of terminal illness?

In regard to the physician narrative, the certification/recertification must include: The statement that the patient's medical prognosis is that their life expectancy is 6 months or less if the terminal illness runs its normal course.

Which of the following professionals must be a core member of the hospice interdisciplinary group according to the Medicare conditions of participation?

The interdisciplinary group must include, but is not limited to, individuals who are qualified and competent to practice in the following professional roles: (i) A doctor of medicine or osteopathy (who is an employee or under contract with the hospice). (ii) A registered nurse. (iii) A social worker.

What is a comprehensive assessment in hospice?

The Hospice Comprehensive Assessment Measure is a single measure that represents the percentage of patient stays in which patients received all seven care processes for which they are eligible. The seven care processes are captured by the seven Hospice Item Set (HIS) QMs.

Who must be involved in completing the hospice comprehensive assessment?

The hospice interdisciplinary group, in consultation with the individual's attending physician (if any), must complete the comprehensive assessment no later than 5 calendar days after the election of hospice care in accordance with § 418.24.

What does a hospice CTI include?

(1) Identification of the particular hospice and of the attending physician that will provide care to the individual. The individual or representative must acknowledge that the identified attending physician was his or her choice.

Get the up-to-date certificate of terminal illness template 2024 now

Here's how it works

The fastest way to redact Certificate of terminal illness template online

See more certificate of terminal illness template versions

Complete this form in 5 minutes or less

Got questions?

What is a CTI for hospice?

What is the current structure of the hospice benefit periods?

What is 1 role of the attending physician for hospice care?

What must be included in or with the physicians narrative as part of an initial hospice certification of terminal disease?

Who are the members of the hospice interdisciplinary team?

Complete this form in 5 minutes or less

People also ask

What should be captured in the physician's narrative on the certification of terminal illness?

Which of the following professionals must be a core member of the hospice interdisciplinary group according to the Medicare conditions of participation?

What is a comprehensive assessment in hospice?

Who must be involved in completing the hospice comprehensive assessment?

What does a hospice CTI include?

physician certification of terminal illness form

Try more PDF tools