HOSPICE REFERRAL

Hospice Referral Form

Physician Referrals

Hospice Referral Form

If you are interested in receiving services for yourself, a family member, or a loved one, please fill out the form below.

For privacy and safety reasons, please do not include any personal health information. If you have questions, need more information, or require immediate assistance, please call us at 803-329-1500.

Physician Referrals

There are two simple ways to refer your patient to Hospice & Community Care:

Fax the referral

803-329-1695

Call our office

803-329-1500

Please include with fax:

Fax Cover Letter (download here)
Referral Form (download here)
Patient Demographic Sheet
History and Physical (H&P)
Progress Notes
Medication List

HOSPICE REFERRAL

Hospice Referral Form

Physician Referrals

Hospice Referral Form

Physician Referrals

Fax the referral

Call our office

Please include with fax:

Our number is 803-329-1500, or you can email us info@hospicecommunitycare.org