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How to use or fill out notification hospice with our platform
- Click ‘Get Form’ to open the notification hospice document in the editor.
- Begin with Section I, which is mandatory for all hospice members. Fill in the member's full name, Member ID, and the date when the Member Election of Hospice Benefit form was signed.
- Next, provide details about the hospice by entering its name and National Provider Identifier (NPI). Include information about the attending physician and their NPI as well.
- Indicate whether the attending physician is employed by the hospice by selecting 'Yes' or 'No'.
- If applicable, complete Section II for members residing in a nursing home at the time of election. Enter the nursing home's name and NPI, along with its level of care.
- For members entering a nursing home after hospice admission, fill out Section III with similar details about the nursing home and include the date admitted.
- If revoking hospice benefits, complete Section IV by providing necessary details such as Member ID and date signed on the revocation form.
- Once all sections are completed accurately, save your changes and follow instructions to submit it to ForwardHealth.
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