There are two types of documents required by hospice care. The first type of document describes the legal or official documents you will be asked to provide during the admissions process. The second type describes documents that the hospice program will ask you to sign.
Documents to Provide Upon Admission
Documents Related to Decision-Making
If any of the following documents have been completed for the patient, provide a copy of each to the hospice admissions coordinator.
- Financial Power of Attorney: The person named in this document is responsible for handling only the person's financial affairs described in the document (this may include payment of bills) if the patient is unable, or does not wish, to do so.
- Advance Directives: These documents allow a person to make health care decisions in advance. The advance directive may specify the type of care the person wants, and/or it may name another individual to give informed consent for medical treatment.
- Order for Guardianship of the Person may be established by a court to appoint a person to give informed consent for medical decisions for a person who is determined by the court to be “disabled” and therefore unable to give informed consent for medical decisions.
- Order for Guardianship of Property may be established by the court to make financial decisions for a person who has been determined by the court to be "disabled" and therefore unable to make financial decisions.
- Do Not Resuscitate (DNR) Order states that the patient does not want to be revived if cardiac arrest occurs or if the person stops breathing.
Health Insurance Documents
The hospice admissions coordinator will request a copy of the patient's health insurance information.
Documents to Sign
Be sure to get a copy of any document you sign, and keep it for your records.
- Consent for Care: This document certifies that the patient or representative understands the nature and scope of hospice care. In the case of community-based hospice, the primary caregiver's name is listed in the document, and that person signs to verify that he or she has made the commitment to be the family caregiver. These documents are slightly different for each hospice program.
- Patient Rights and Responsibilities: This form outlines patient rights as required by state regulation. Patient responsibilities are listed, including the provision of accurate health information and participation in the care plan. Again, the wording on the form differs for each hospice program.
- Medicare Hospice Benefit Election Form (if the patient has Medicare): This document certifies that the patient or representative understands the services provided by hospice, and the rights of patients to change providers or discontinue hospice care. The Medicare form also states that Medicare may make payments to other providers for services that are not related to the terminal illness.
- Medicare Secondary Payer: This is a checklist that ensures that Medicare is the primary payer. The form will ask whether the illness was caused by an accident, or is covered by Workman's Compensation or some other payer.
- Commercial Service Agreement: If the patient has private health insurance, this form is signed. It outlines what the insurance company covers, and what the patient's responsibility is.
- Authorization to Release Information: This gives permission for the hospice program to give information about the patient to the insurance company or other agencies involved in the patient's care.
It is important that the appropriate person sign the documents indicated above.
- If the patient is capable of understanding the documents and there is no legal decision-maker (power of attorney or guardian of property), the patient is the appropriate person.
- If a family member or friend has informally agreed to pay bills for the patient, he or she should sign.
- If the patient is not capable of understanding the documents and there is a formal arrangement for decision-making (power of attorney or guardian of property), the power of attorney or guardian of property should sign the documents.
- If the patient is not capable of understanding the documents and there is no power of attorney or guardian of property, the surrogate decision-maker identified under Maryland law may be asked to sign the documents.
Documents Related to Care or Treatment of the Participant
- If there is a guardian of person, that individual should sign the documents.
- If there is no guardian of person, the patient should sign if they are capable of understanding the documents. If not, the surrogate decision-maker identified under Maryland law may be asked to sign.
For information about wills, estates and probate or to learn how to register a will, the Maryland Register of Wills offers information and links to local registers.