Maxcare Hospice has supported Orange County physicians, case managers, discharge planners and social workers since 2011. We are a Medicare-certified hospice (CCN 551689) based in Westminster, and we have Vietnamese-speaking staff.
How to refer
- Call us at (714) 844-7777. Nurses are on call 24/7, and the office is open Mon–Fri 9:00–5:30.
- Send records. Call for fax and secure transmission instructions. Please don’t send patient information through website forms or regular email.
- We coordinate. Our team contacts the patient or family to schedule an evaluation and keeps you updated. We’ll call you back as soon as possible.
What to send
A referral can start with a phone call. Our intake team will tell you which documents they still need. The more of these we receive, the faster eligibility can be confirmed:
- Patient name, date of birth and phone number (send through a secure channel, not this website)
- Signed physician order or referral for hospice evaluation
- Primary terminal diagnosis and relevant secondary or comorbid conditions
- Recent history & physical and progress notes showing decline
- Medication list and allergies
- Recent labs, imaging or other diagnostic results that support the prognosis
- Functional status: PPS or Karnofsky score, ADL dependence, FAST stage for dementia
- Evidence of decline: weight loss, recurrent infections, ER visits or hospitalizations in the past 6 months
- Insurance information (Medicare, Medi-Cal or other) and face sheet
- Advance directive, POLST and code status, if available
- Attending physician who will follow the patient (yes/no), plus contact information
- Caregiver or decision-maker name and phone; preferred language (we have Vietnamese-speaking staff)
- Care setting: home, assisted living, board and care, or skilled nursing facility
Hospice eligibility documentation checklist
- Physician certifies a terminal illness with a prognosis of 6 months or less if the disease runs its normal course
- Patient or representative chooses comfort-focused care over curative treatment for the terminal illness
- Clinical findings support the prognosis, for example declining PPS, weight loss, increasing ADL dependence or frequent hospitalizations
- Disease-specific indicators are documented (see our hospice eligibility guidelines)
- Face-to-face encounter documented when required for recertification
Contact
Maxcare Hospice · 13800 Arizona St #201, Westminster, CA 92683
Phone: (714) 844-7777 · Fax: call for fax
Office hours Mon–Fri 9:00–5:30 · Nurses on call 24/7
Request a free hospice evaluation
Leave your name, phone and ZIP code. We’ll call you back as soon as possible. Need help now? Nurses are on call 24/7 at (714) 844-7777.
Talk with a hospice nurse
Nurses on call 24/7. Office hours Mon–Fri 9:00–5:30. Vietnamese-speaking staff.
Maxcare Hospice · 13800 Arizona St #201, Westminster, CA 92683 · Medicare-certified (CCN 551689)
We speak your language: English · Tiếng Việt · 한국어 (Korean-speaking nurse) · ACHC-accredited · Nurses on call 24/7 · (714) 844-7777
Helpful pages: Download our referral checklist
