Palliative Care Templates

This document is used in Missouri to establish and confirm a person's terminal condition, which is a medical condition that is irreversible and expected to result in death within a short period of time. It helps in making important decisions regarding end-of-life care and treatment options.

This Form is used for obtaining consent for palliative care in Oklahoma.

This form is used for requesting additional palliative care in Rhode Island. It allows individuals to seek additional medical support for managing pain and symptoms related to a serious illness or condition.

This document explains the Medicare hospice benefits available to individuals who have a terminal illness and are receiving hospice care. It includes information on what services are covered, eligibility requirements, and how to apply.

This legal form encompasses the orders concerning your wishes about your future medical care in the state of Alabama. The document comes into play in the event of severe medical situations in which you are not able to communicate your wishes or make decisions.

Use this form in the state of South Carolina for a potential situation when a medical issue leaves you unable to express your wishes about medical treatment.

Download this form to state your wishes regarding your preferences for your healthcare in the event you are no longer able to decide for yourself.

Fill out this document to indicate your wishes about the health care measures to be taken in the event of your possible mental incapacity.

Print out this Kansas will to pre-organize your health care in a potential scenario, prevent major arguments between your family members, control any necessary medical treatments and procedures and reduce potential extra medical bills.

Print out this will to pre-organize your health care in a potential scenario, prevent major arguments between your family members, control any necessary medical treatments and procedures and reduce potential extra medical bills in the state of Washington.

This document is for requesting a special license plate in Arkansas that supports hospice and palliative care services.

This form is used for nursing facilities in Texas to provide palliative care for patients. It helps ensure that patients receive appropriate treatment and support during end-of-life care.

This document provides information about the Medicare Hospice Benefit, which is a program that covers hospice care for terminally ill patients. It explains the eligibility criteria, services covered, and how to access this benefit.

This document provides instructions for completing Form FA-24A which is used for coordinating hospice services and waiver or personal care services (PCS) in Nevada.

This document is an Appendix III for the state of Alabama related to Pediatric Palliative and End of Life (PPEL) Care. It outlines the specific order and guidelines for providing palliative care to children in Alabama.

This document is used for recording progress notes and creating checklists for palliative care in Oklahoma.

This document is a Medical Orders for Scope of Treatment form specific to the state of South Dakota. It is used for outlining an individual's preferences for medical treatment, including end-of-life decisions and resuscitation orders.

This form is used to instruct health care providers to not do CPR for the patient if their heart stops beating.

This document is for those seeking a referral for home care services in Prince Edward Island, Canada. It provides information and assistance in finding reliable and professional home care providers in the area.

This Form is used for recording information about pediatric palliative care in Spanish language.

This form is used for giving consent for palliative care in the state of Oklahoma.

This document outlines the plan of care for children receiving palliative care services in Vermont's Pediatric Palliative Care Program. It includes comprehensive information on the medical treatment, support, and services provided to the child and their family.

This Form is used for requesting additional services for the Pediatric Palliative Care Program (PPCP) in Vermont.

This document is used for Clinician Orders for DNR/CPR and other life-sustaining treatments in Vermont.

This Form is used for appointing a health care agent to make medical decisions on your behalf in Massachusetts.

This chart is used in aged care settings to track and assess pain levels in elderly individuals.

This document is for the Illinois residents and is used to request and guide medical practitioners on life-sustaining treatment decisions. It is available in English and Chinese languages.

This form is used for practitioners in Illinois to record a patient's decisions regarding life-sustaining treatment. It is available in both English and Chinese Simplified languages.

This document outlines the medical plan for treating an individual diagnosed with cancer. It includes details about the recommended treatment options, such as surgery, radiation therapy, chemotherapy, or targeted therapy. The cancer treatment plan aims to provide the best possible care and increases the chances of recovery.

This document provides a template for crafting a letter regarding end-of-life care decisions, particularly for clarifying preferences and wishes about medical and care measures during terminal illness or nearing death situations.

This form is used for reporting patient choice at the end of life by physicians in Vermont.