INITIAL PHYSICIAN CERTIFICATION - hospiceoflansing 2026

1. Click ‘Get Form’ to open the INITIAL PHYSICIAN CERTIFICATION in the editor.
2. Begin by entering the patient's name and chart number at the top of the form. This information is crucial for accurate record-keeping.
3. In the Patient Certification section, provide a detailed terminal diagnosis along with a narrative that supports this diagnosis. Ensure you complete the signature section with your printed name and date.
4. Designate a physician responsible for patient care by selecting one of the options provided. If you choose to manage care yourself, include your contact information for any necessary follow-ups.
5. Indicate who will sign the death certificate by selecting one of the options available. This ensures clarity on responsibilities.
6. Once all fields are completed, review your entries for accuracy before submitting. You can easily save or print your document directly from our platform.

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