Referring A Patient

Referring A Patient

Online Hospice Patient Referral Form:

 





Patient Information:

Name: First /Last / MI (required):

Street:

Apt#:

City:

State:

Zip:

Home Phone:

Date of Birth:

Patient Location:

 Home Hospital Skill Nursing Facility RCFE Other

Faculty Name:

Contact Person:

Name: First /Last / MI (required)

Street:

Apt#:

City:

State:

Zip:

Home Phone:

Email: (required)

refer a patient to hospice care

You don’t have to be a doctor to make a referral

Anyone who feels a loved one or patient is in the advanced stages of a life-limiting illness and would benefit from hospice services can make a referral for care.

Our intake staff will work with the physician to complete the necessary paperwork and streamline the admission process.

In most cases, a patient is admitted to Avalon Hospice & Palliative Care within 48 hours.After hours, on weekends and holidays, our phone number will be answered by the On-Call RN.

Call 858-751-0315 & Press 1 to connect to a hospice nurse.

 

palliative care San Diego

 

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Hospice & Palliative Care San Diego