This customizable document, Hospice Election Statement, is taken from MCN Healthcare’s Hospice Policy and Procedure Manual. For more than 20 years, MCN has been the health care industry’s leading provider of policy and procedure templates, forms, competencies and other compliance tools.

Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards.

Here is some sample content from Hospice Election Statement:

	POLICY: Patients who are eligible for Medicare Part A or Medicaid Hospice Benefits and have met the criteria for Hospice care must sign a Hospice Election Statement. The Election Statement explains the Medicare or Medicaid Hospice Benefit coverage, and the signature of the patient/patient's legal representative gives agreement to care. The Election Statement must include the following: Identification of the particular Hospice that will provide care to the individual The individual's or representative's acknowledgment that he or she has been given a full understanding of the palliative...
Second excerpt:
	...the election, which may be the first day of Hospice care or a later date, but may be no earlier than the date of the Election Statement The signature of the individual or representative Duration of Hospice Care Coverage - Election Periods § 418.21: Subject to the conditions set forth, an individual may elect to receive Hospice care during one 1 or more of the following election periods: An initial 90-day period A subsequent 90-day period or An unlimited number of subsequent 60-day...