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:

    HomeHospitalSkill Nursing FacilityRCFEOther

    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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