Hospice Admission Consent

Start

Start a new hospice admission consent.

Find an existing patient by name and correct it.

Patient information

Name * (legal)

DOB (MM/DD/YYYY)

MBI (Medicare ID)

SSN (last 4)

Patient email *

Patient mobile (SMS, optional, +1…)

Agency & form

Hospice / agency *

Consent template *

Provider email * (final copy goes here)

Fix from a signed / filled packet (one upload → everything)

Drop the existing signed consent packet — it pulls the patient identity and the diagnoses out of it in one shot, so you can review and re-stamp a clean copy. Nothing is saved.

Auto-fill from facesheet (optional)

Upload a facesheet PDF to pre-fill patient identity. Nothing is saved — the file is read on the server, parsed, and discarded. Review every field before creating.

Suggest diagnoses from chart (optional)

Upload the hospital chart PDF to rank likely terminal diagnoses and suggest related / unrelated conditions. Nothing is saved — you pick and confirm before it fills the Clinical tab.

Clinical details

These fill the packet's clinical sections. Identity + agency defaults (IDG team, levels of care, medical director, dates) are filled automatically.

Admission / start-of-care date (MM/DD/YYYY)

Benefit period

Terminal diagnosis (ICD-10 + description)

Related condition 1

Related condition 2

Primary caregiver name

Caregiver relationship

Caregiver phone

Signer initials (Photo/Video lines)

Patient is unable to sign personally (surrogate signs)

If unable, reason (≤40 chars)

Review & issue

Create the consent to send it to the patient, or download a corrected packet to review the stamped PDF without saving.

System activity

Live activity log

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Time	Event	Actor	Channel	Consent	Detail
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