Hospice Patient Emergency Contact Form

When providing compassionate hospice care, having immediate access to emergency contact information, comfort care preferences, and end-of-life wishes is essential for honoring patient dignity and family needs during difficult moments.

This Hospice Patient Emergency Contact Form is designed specifically for hospice providers, palliative care teams, and end-of-life care facilities to collect comprehensive information in one organized, respectful place. The form captures primary and secondary emergency contacts, comfort care preferences, spiritual advisor details, funeral arrangement instructions, and a clear family notification order.

Built with Paperform, this template provides a sensitive, easy-to-complete experience for patients and their families. The doc-style editor allows you to customize language to match your hospice's compassionate tone, add your logo and branding, and organize questions in a way that feels supportive rather than clinical.

Use conditional logic to show relevant follow-up questions based on patient preferences—for example, displaying spiritual advisor contact fields only if spiritual support is requested. Connect submissions to your care management system via Stepper (stepper.io) to automatically update patient records, notify care coordinators, and trigger gentle reminder workflows for care plan reviews.

For organizations requiring secure documentation, integrate with Papersign (papersign.com) to collect signatures on advance directives or comfort care agreements, keeping everything linked to the original patient intake for a complete, compliant care file.

This template is trusted by hospice care teams, palliative care programs, home healthcare providers, and senior care facilities who need to balance thorough information gathering with the sensitivity that end-of-life care demands. Whether you're onboarding new hospice patients or updating existing care plans, this form helps ensure that every patient's wishes and their family's needs are clearly documented and honored.