Patient Eligibility

Eligibility Requirements

Life-limiting illness with a prognosis of 6 months or less
Patient has a declining functional status as determined
By either:
- Palliative Performance Scale of 50% or less
- Dependence in 3 out of 6 Activities of Daily Living
- Frequent hospitalizations
- Frequent trips to the Emergency Room
- Weight loss of 10% or more in the last 4 to 6 months
- Serum Albumin less than 2.5 gm / dl
- Patient and family have elected palliative care
- Documented clinical disease progression

Palliative Performance Scale

Indicates patient’s ability to function independently.

Serum Albumin

Albumin is a component of protein and makes up one half of plasma protein.

We have created a form which can help you determine if Hospice care is right for you. Click here to download a form check your eligibility or click here to submit an online request to receive additional information about Hospice services.

End Stage Diagnosis

Although commonly assumed, Hospice care is not just for Cancer patients. Hospice of South Texas provides care to patients with any End Stage Diagnosis. These may include, but are not limited to:

Metastatic Malignancies
Heart Disease
Kidney Disease
Liver Disease
Lung Disease
Stroke and/or Coma
AIDS
Neurological Diseases (Alzheimer’s, Parkinson’s, Dementia, etc.)
Lou Gehrig’s (ALS) Disease

Physicians

Hospice improves the quality of life for patients living with serious illness. Our care can benefit patients the most when started sooner in the disease process. Referring your patients to Hospice should also be viewed as simply prescribing a new approach to a terminal illness—and certainly never a surrender. By referring your patients sooner, more time is allowed to focus on the patient’s and family’s concerns, and to establish a comprehensive care plan and administration for their physical, spiritual, and emotional needs. Please complete the form below. Hospice of South Texas will contact you to schedule your patient’s referral.

Patient Details
Name*
First Last
Email
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Patient Needs
Referral Details
Your Name*
First Last
Your Email
Your Phone*
Additional Comments
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Facilities

Patient Details
Name*
First Last
Email
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Patient Needs
Referral Details
Your Name*
First Last
Your Email
Your Phone*
Additional Comments
CAPTCHA