Mission Hospice & Home Care 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 & Home Care 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