Hospice Eligibility Assessment & Care Readiness Form

Compassionate Hospice Care Assessment Made Simple

When families are considering hospice care, the conversation requires sensitivity, clarity, and thorough understanding. This Hospice Eligibility Assessment & Care Readiness Form helps healthcare providers, hospice agencies, and care coordinators gather essential information while respecting the emotional nature of end-of-life care decisions.

Designed for Healthcare Providers and Hospice Services

Whether you're a hospice agency, palliative care coordinator, social worker, or healthcare administrator, this template streamlines the intake process while maintaining the dignity and compassion these conversations require. The form helps you understand:

• Medical eligibility criteria and current care needs
• Readiness for prognosis discussions among patients and family members
• Care philosophy alignment between the family's values and hospice services
• Service scope understanding to set appropriate expectations

A Sensitive, Professional Approach

Unlike standard medical forms, this template is crafted with language that balances clinical necessity with emotional sensitivity. It guides respondents through complex topics—from prognosis awareness to spiritual care preferences—in a way that feels supportive rather than clinical.

The conditional logic built into the form ensures families only see questions relevant to their situation, reducing overwhelm during an already difficult time. This thoughtful design improves completion rates while gathering the detailed information your team needs for care planning.

Streamline Care Coordination with Paperform + Stepper

Once submitted, this form can trigger your entire care coordination workflow using Stepper (stepper.io). Automatically route assessments to the appropriate care team members, schedule follow-up calls, create care plans in your system, and send personalized resources to families—all without manual data entry.

For organizations requiring signed consent forms or advance directive documentation, Papersign (papersign.com) seamlessly converts submissions into legally binding eSignature documents, maintaining a complete audit trail linked to the original assessment.

HIPAA Considerations

Please note that while Paperform offers SOC 2 Type II compliance and robust security features, it is not HIPAA compliant. For protected health information (PHI), ensure you're using this form in accordance with your organization's privacy policies and compliance requirements, or consider it for pre-screening and general care philosophy discussions rather than detailed medical records.

Built for Care Teams Who Value Compassion and Efficiency

Trusted by healthcare providers who understand that even administrative processes can be delivered with warmth and professionalism, this template helps you focus on what matters most: providing exceptional end-of-life care that honors each patient's wishes and supports their loved ones through one of life's most challenging transitions.