Residential Hospice Application Form

Streamline Hospice Admissions with Compassionate, Professional Forms

When families are navigating end-of-life care decisions, the last thing they need is complicated paperwork or impersonal administrative processes. Our Residential Hospice Application Form template helps hospice care providers collect essential medical information, advance directive documentation, and care preferences with the sensitivity and professionalism this moment deserves.

Why Hospice Care Providers Choose Paperform

Hospice administrators, case managers, and healthcare coordinators trust Paperform to handle one of healthcare's most delicate admission processes. This template replaces scattered PDFs, faxed forms, and incomplete email submissions with a single, secure digital experience that families can complete at their own pace, from anywhere.

The template includes:

• Patient and next-of-kin contact information with emergency contacts
• Terminal diagnosis documentation and physician information
• Secure file upload for DNR orders and advance directives
• Detailed care preferences and comfort measures
• Family visitation schedules and preferences
• Insurance and payment information collection
• Cultural, spiritual, and end-of-life wishes

Design That Respects the Moment

Unlike rigid medical forms, Paperform's doc-style editor lets you present questions with warmth and clarity. Add compassionate messaging, explanatory text between sections, and gentle transitions that guide families through what can be an emotionally overwhelming process. The form adapts beautifully to mobile devices, so families can complete it from a hospital waiting room, at home, or wherever feels right.

You can customize the visual design to match your hospice's brand—choosing calming colors, appropriate fonts, and adding your logo—creating a consistent, professional experience that builds trust during a vulnerable time.

Secure Document Collection & HIPAA Considerations

This template includes file upload fields for critical documents like DNR orders, advance healthcare directives, terminal diagnosis letters, and insurance cards. All submissions are encrypted and stored securely within Paperform's SOC 2 Type II compliant infrastructure.

While Paperform offers robust security measures suitable for many healthcare applications, please note that Paperform is not HIPAA compliant. Healthcare organizations subject to HIPAA requirements should consult with their compliance team to determine appropriate use cases, consider additional safeguards, or explore Paperform's Enterprise options for enhanced security features and business associate agreements where available.

Workflow Automation with Stepper

Once an application is submitted, Paperform's integration with Stepper (stepper.io) can transform your intake workflow:

• Automatically notify your admissions team, medical director, and care coordinators
• Create patient records in your hospice management system
• Route applications for medical review and approval
• Trigger family welcome emails with next steps and facility information
• Schedule intake appointments and care team assignments
• Generate internal checklists for room preparation and medication orders

These automations reduce administrative burden on your staff, ensuring no application falls through the cracks and families receive timely communication during a critical time.

Built for Healthcare Operations Teams

This template is ideal for:

• Hospice Care Facilities: In-patient residential hospice centers managing admissions
• Palliative Care Programs: Transitioning patients to hospice-level care
• Senior Care Communities: Facilities offering hospice wings or end-of-life care
• Healthcare Case Managers: Coordinating hospice placement for terminal patients
• Home Health Agencies: Evaluating residential hospice candidacy

The conditional logic built into Paperform means you can show different questions based on previous answers—for example, only displaying insurance secondary coverage fields if someone indicates they have it, or showing specific spiritual care questions based on religious preferences indicated earlier in the form.

Integrations That Keep Your Team Connected

Connect submissions directly to the tools your hospice team already uses:

• Send alerts to Slack channels for immediate team notification
• Log applications in Google Sheets or Airtable for tracking and reporting
• Push data to your CRM or patient management system
• Trigger follow-up workflows in Stepper, Zapier, or Make
• Generate confirmation emails with personalized next steps

Compliance, Privacy & Trust

Families entrusting their loved ones to your care need to know their sensitive information is protected. Paperform provides:

• SOC 2 Type II certification for data security
• GDPR compliance for privacy rights
• Data residency options to control where information is stored
• Role-based permissions so only authorized staff access applications
• Secure file uploads with encryption in transit and at rest

Your Trust Center provides transparency around security practices, giving families and compliance officers confidence in your digital processes.

Getting Started

You can customize this template to match your hospice's specific intake requirements, clinical protocols, and state regulations. Add your facility's contact information, adjust medical questions for your region's advance directive requirements, or include fields for specialized programs like music therapy, pet visitation, or chaplain services.

Start with Paperform's free plan to test the template, then scale to Essentials, Pro, or Enterprise tiers as your patient volume grows and you need advanced features like SSO, custom domains, or white-label branding.

Compassionate care starts with a compassionate intake process. This Residential Hospice Application template helps you honor the dignity of every patient and family from the very first interaction, while giving your team the structure and automation they need to deliver exceptional end-of-life care.

Paperform is trusted by healthcare providers worldwide for secure, professional forms and workflows. With 30,000+ templates, SOC 2 Type II compliance, and powerful integrations, it's the platform built for teams who need both simplicity and security.