SAMARITAN hospice patient REFERRAL FORMhospice patient referral

Are you a healthcare professional who believes that your patient meets the admission criteria for hospice?

Is your loved one seriously ill? Are you unsure if the time is right for hospice and have some questions? Perhaps you are unsure of what qualifies a patient for hospice admission? Or when a hospice patient referral is appropriate?

Samaritan can help. 

Knowing when to refer someone for a hospice evaluation can be difficult.

When is the right time to ask about hospice?

Now is the best time to learn more. Although end-of-life care may be difficult to discuss, it's best for family members to share their wishes long before it becomes a concern.

Hospice care isn't giving up. It’s ensuring that your loved one or patient is as comfortable as possible during the time he or she has left.

Six Months of Less to Live

A person of any age is eligible for hospice after being certified by a physician as having a life expectancy that may be six months of less, depeinding on the course of the disease.

General Signs & Symptoms

The following signs and symptoms may indicate when a a hospice care referral is appropriate:

  • Increased or uncontrolled pain
  • Progressive weight loss
  • Swallowing difficulties
  • Shortness of breath
  • Nausea/vomiting that does not respond well to medications
  • Increased edema or ascites
  • Decline in ability to perform activities of daily living
  • Frequent infections
  • Frequent hospitalizations or ER visits
  • Increased weakness and/or fatigue
  • Increased skin problems
  • Withdrawal, confusion, bedbound
  • Progressive decline, inspite of curative treatments.

Fill out the hospice patient referral form below if you would like more information on our hospice care program. Someone will be in touch with you within 24 hours. Not every eligible patient will exhibit every hospice referral trigger. When in doubt, please call our expert nurses at (800) 229-8183 to learn more about hospice care criteria, discuss your patient's or loved one's specific needs, or to arrange for an assessment visit.

Online Referral Form

Person Submitting Form
Patient Bio

Samaritan Healthcare & Hospice

Samaritan is South Jersey's leading provider of hospice and palliative care.
Not-for-profit | Independent | Non-sectarian


5 Eves Drive, Suite 300 Marlton, NJ 08053
Phone: (800) 229-8183 | EMAIL


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