Download Your Applicable Hospice Care Admission Forms

After you have had a conversation with a member of the Minnesota Hospice care team, please download the applicable consent/election documents listed below. Please note that part of obtaining your informed consent includes providing you with the following documents: Notice of Privacy Practices, Understanding Advance Directives and Patient Rights and Responsibilities. Please be sure you sign and date the Patient Consent for Care, Election of Hospice, Do Not Resuscitate (DNR) and Authorization to Release Health Information. In addition, be sure to indicate the date that hospice care will start (if different from the date you are signing). Also, include your choice for attending physician on the Election of Hospice form.

All admission forms should be faxed to Minnesota Hospice at 952.898.4006 or scanned to info@mnhospice.com.

Admission Form

Authorization to Release Health Information Form

Provider Form

Physician Evaluation & Treatment Order