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Patient Qualifications Hospice Patient Qualifications

Healthcare professionals, family members, friends, or patients themselves may request hospice services.

An individual is eligible for hospice care if they have an estimated prognosis of six months or less. Too often patients are referred in the last weeks or even days of their lives. The earlier a patient is admitted to the program, the greater the benefit to the patient, caregiver, and family.

What Are the Eligibility Requirements for Hospice Care?

All patients must meet federally-defined eligibility criteria in order to qualify for admission to the program, but the initial referral can come directly from someone close to the patient.

Patients must meet the following criteria:

  • Certification of a terminal illness with a prognosis of six months or less if the disease follows its normal course.
  • Desire for comfort care rather than curative care.

How do I Refer a Patient to Hospice of the Piedmont or Hospice of Randolph?

  1. Complete a Referral Form online.
  2. To fax in referral information, please download our Referral Form, complete, and fax it to 336.889.3450.

For provider referrals:

  • If your provider records are available through EPIC, no further patient documentation is needed. Otherwise, please include any potentially helpful patient information with your referral submission, including:
    • Demographic/Face sheet
    • Provider’s notes (last 3 visits)