Referral Order Form - Pathways Hospice - pathways-care 2026

1. Click ‘Get Form’ to open the Referral Order Form in the editor.
2. Begin by filling in the 'To', 'From', and 'Fax' fields at the top of the form. This information is essential for proper communication.
3. Enter the date and patient details, including their name and date of birth (DOB). Select whether this is a hospice referral, palliative care referral, or both by checking the appropriate box.
4. If available, upload any required documentation such as the face sheet, current medication list, applicable labs, and recent physician notes using our platform's upload feature.
5. For palliative care referrals, check all relevant reasons listed. This helps ensure that the patient's needs are accurately communicated.
6. Indicate whether Pathways Palliative Care has permission to prescribe medications by checking 'YES' or 'NO'.
7. Fill in the physician's name and provide their signature. Specify if this is an urgent referral by checking 'YES' or 'NO'.
8. Finally, choose your preferred method of update after the initial consultation—either phone or fax.

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