Mission Hospice - It's About Life - Compassionate Care and Comfort When it's Needed Most

Information for Physicians

Mission Hospice welcomes your referrals and the opportunity to serve your patients.

Fax Referrals: View and print a Fax Referral Form. Once completed, please fax the form to Mission Hospice at (650) 554-1018.

Telephone Referrals: Please call Barbara Feduska, RN, Director of Patient Services, at (650) 554-1000.

Please provide the following information:

  • Patient’s Name
  • Patient’s Phone Number
  • Patient’s Date of Birth
  • Patient’s Social Security Number
  • Emergency Contact Information
  • Allergies
  • Homebound Status
  • Last MD Office Visit
  • Doctor’s Name
  • Doctor’s Phone Number
  • Diagnosis: Current and Other Significant Medical Data
  • For Hospice: Estimated prognosis of six months or less; please call to discuss eligibility
  • Specific Orders for Care
  • Insurance Carrier, Phone Number and Policy Number
  • Name of Policy Holder