{"product_id":"hospice-waiver-application","title":"HOSPICE WAIVER APPLICATION","description":"\u003ch1\u003e\u003cspan\u003e🏥 Hospice Waiver Application – Professional Notification \u0026amp; Documentation Form\u003c\/span\u003e\u003c\/h1\u003e\n\u003ch3\u003e\u003cspan\u003eRCFE \u0026amp; Assisted Living Compliance Template\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cstrong\u003e\u003cspan\u003eRosenthal Community Care Services\u003c\/span\u003e\u003c\/strong\u003e\u003c\/p\u003e\n\u003cdiv\u003e\u003chr\u003e\u003c\/div\u003e\n\u003ch2\u003e\u003cspan\u003e📋 Ensure Proper Hospice Communication \u0026amp; Regulatory Compliance\u003c\/span\u003e\u003c\/h2\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003eThe \u003c\/span\u003e\u003cstrong\u003e\u003cspan\u003eHospice Waiver Application Form\u003c\/span\u003e\u003c\/strong\u003e\u003cspan\u003e by \u003c\/span\u003e\u003cstrong\u003e\u003cspan\u003eRosenthal Community Care Services\u003c\/span\u003e\u003c\/strong\u003e\u003cspan\u003e is a professionally designed, \u003c\/span\u003e\u003cstrong\u003e\u003cspan\u003enon-editable digital documentation tool\u003c\/span\u003e\u003c\/strong\u003e\u003cspan\u003e created for \u003c\/span\u003e\u003cstrong\u003e\u003cspan\u003eRCFE (Residential Care Facilities for the Elderly), ARF (Adult Residential Facilities), Assisted Living Facilities, Board and Care Homes, Memory Care Facilities, and Hospice Care Providers\u003c\/span\u003e\u003c\/strong\u003e\u003cspan\u003e.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003eThis form is used to formally document and communicate a resident’s \u003c\/span\u003e\u003cstrong\u003e\u003cspan\u003echange in condition or behavior\u003c\/span\u003e\u003c\/strong\u003e\u003cspan\u003e, along with required notifications to both \u003c\/span\u003e\u003cstrong\u003e\u003cspan\u003efamily\/conservators and physicians\u003c\/span\u003e\u003c\/strong\u003e\u003cspan\u003e, ensuring timely medical coordination and compliance with facility and hospice care requirements.\u003c\/span\u003e\u003c\/p\u003e\n\u003cdiv\u003e\u003chr\u003e\u003c\/div\u003e\n\u003ch2\u003e\u003cspan\u003e📄 Purpose of This Form\u003c\/span\u003e\u003c\/h2\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003eThe Hospice Waiver Application is used to document a resident’s change in health status and facilitate proper communication between the facility, family or conservator, and the attending physician.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003eIt ensures that all relevant parties are informed of the resident’s condition, physician recommendations, and any required medical or care plan adjustments.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003eThis form supports structured documentation for \u003c\/span\u003e\u003cstrong\u003e\u003cspan\u003ecare escalation, hospice coordination, and medical decision-making processes\u003c\/span\u003e\u003c\/strong\u003e\u003cspan\u003e.\u003c\/span\u003e\u003c\/p\u003e\n\u003cdiv\u003e\u003chr\u003e\u003c\/div\u003e\n\u003ch2\u003e\u003cspan\u003e📑 Section 1: Notification to Family \/ Conservator\u003c\/span\u003e\u003c\/h2\u003e\n\u003ch3\u003e\u003cspan\u003e🏡 Facility Information\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Name of Facility\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Facility License Number\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Facility Address\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Administrator Name\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Phone Number\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003e\u003cspan\u003e👨👩👧 Family \/ Conservator Contact\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Recipient Name (TO)\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Phone Number\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Address\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Fax Number\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003e\u003cspan\u003e👤 Resident Information\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Resident Name\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003e\u003cspan\u003e📝 Change in Condition Report\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Description of change in resident condition or behavior\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Physician recommendations section\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003e\u003cspan\u003e📞 Communication Record\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Notification by phone completed\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Date of notification\u003c\/span\u003e\u003c\/p\u003e\n\u003cdiv\u003e\u003chr\u003e\u003c\/div\u003e\n\u003ch2\u003e\u003cspan\u003e📑 Section 2: Notification to Physician\u003c\/span\u003e\u003c\/h2\u003e\n\u003ch3\u003e\u003cspan\u003e🏥 Facility Information\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Name of Facility\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Facility License Number\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Facility Address\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Administrator Name\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Phone Number\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003e\u003cspan\u003e👨⚕️ Physician Contact Information\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Physician Name (TO)\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Phone Number\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Address\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Fax Number\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003e\u003cspan\u003e👤 Resident Information\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Resident Name\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003e\u003cspan\u003e📝 Medical Update Section\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✔ Change in condition details requiring physician review\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Instructions for care plan actions\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Current medications list\u003c\/span\u003e\u003c\/p\u003e\n\u003cdiv\u003e\u003chr\u003e\u003c\/div\u003e\n\u003ch2\u003e\u003cspan\u003e⭐ Key Features\u003c\/span\u003e\u003c\/h2\u003e\n\u003cp class=\"isSelectedEnd\"\u003e\u003cspan\u003e✅ Professional non-editable PDF form\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✅ Dual notification system (Family + Physician)\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✅ Designed for RCFE, ARF, Assisted Living \u0026amp; Hospice coordination\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✅ Supports change-in-condition reporting and care escalation\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✅ Helps maintain compliance and accurate resident records\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✅ Structured for medical and administrative communication\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✅ Instant digital download\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✅ Print-ready format\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e⚠️ No physical product shipped\u003c\/span\u003e\u003c\/p\u003e\n\u003cdiv\u003e\u003chr\u003e\u003c\/div\u003e\n\u003ch2\u003e\u003cspan\u003e🏡 Ideal For\u003c\/span\u003e\u003c\/h2\u003e\n\u003cp\u003e\u003cspan\u003e✔ Residential Care Facilities for the Elderly (RCFE)\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Adult Residential Facilities (ARF)\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Assisted Living Facilities\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Board and Care Homes\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Memory Care Facilities\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Hospice Care Providers\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Facility Administrators\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Nurses \u0026amp; Care Coordinators\u003c\/span\u003e\u003cbr\u003e\u003cspan\u003e✔ Compliance Officers\u003c\/span\u003e\u003c\/p\u003e","brand":"Rosenthal Community Care Services","offers":[{"title":"Generic","offer_id":51260980724018,"sku":null,"price":3.99,"currency_code":"USD","in_stock":true},{"title":"Branded","offer_id":51260980756786,"sku":null,"price":7.99,"currency_code":"USD","in_stock":true}],"url":"https:\/\/rosenthalcommunitycare.com\/products\/hospice-waiver-application","provider":"Rosenthal Community Care Services","version":"1.0","type":"link"}