If you wish to contact us with a referral from the patient’s primary care provider or the hospital, we will need copies of medical records and a written Order for Hospice. We’ll send you a faxed request or ask for these documents when you call. We also need you to fill out one of the Yolo Hospice Medicare Evaluation Tools below. Use the online forms below and the Order for Hospice form, or download, print, and fax both the Order for Hospice and the Yolo Hospice Medicare Evaluation tool to us at (530) 758-9017.
Online Forms
Please click on the links below to complete the Yolo Hospice Medicare Evaluation Forms online.
- Cancer
- ALS
- HIV
- Stroke/Coma
- End Stage Alzheimer’s
- End Stage Heart Disease
- End Stage Liver Disease
- End Stage Pulmonary Disease
- End Stage Renal Disease
Download Forms
Please click on the links below to download the Yolo Hospice Medicare Evaluation Forms to be printed and submitted by fax.
