Refer a Patient

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Information for Physician’s Offices and Discharge Planners

To help ensure patient confidentiality, we request that confidential patient information be kept from emails.

We are able to take your referral from most proprietary systems.

Referrals may be made by phone or fax.

KANSAS CITY HOSPICE FAX FORM NORTHCARE HOSPICE FAX FORM

CALL (816) 276-2700    FAX (816) 444-1928

To refer a patient, the following information is required and may be faxed:

  • The service your patient needs:

Palliative Home Care – for patients not ready for hospice, with skilled nursing needs. Patient must be homebound.
Hospice at Home, Assisted Living or Long-Term Care Facility.
Kansas City Hospice House™ – inpatient care to control pain or stabilize symptoms.
NorthCare Hospice House – inpatient care to control pain or stabilize symptoms.
Request a consultation to discuss options

  • Your name and contact information
  • Patient name and contact information
  • Diagnosis code(s)
  • Attending physician Cardiologist (if a cardiac patient)
  • History & Physical, Discharge Summary and Discharge Orders
  • Facesheet or document with DOB, SSN, address, insurance and primary contact
  • Current medication list Medicare Part D information or copy of card, if available
  • Physician signature, date and time