Please fill out the Hospice House Referral Information form (linked below) to begin the admission review process:
Please send the following information in addition to the referral form above:
1. DNR (Post form is not acceptable)
2. Hospice Election Statement (Hospice Agency of Choice for Family)
3. Face sheet
4. History and Physical
5. Palliative Care and Hospice notes
6. Medication list
7. Results of a negative PCR Covid test regardless of vaccination status (patient may require negative flu or TB test depending on diagnosis)
8. Name and phone number of contacts
9. Pharmacy name and phone number that will be delivering or sending the medications
Once all the above information is received and reviewed, a member of the Hospice House of Williamsburg Clinical Team will contact you to inform you of possible admission and bed status.
Note:
Admissions are accepted Monday through Friday.
Transportation MUST be scheduled no later than 1pm.
Medication is to arrive the night prior or to arrive with the patient.
Oxygen and suction equipment must arrive prior to the patient’s admission.
Please direct questions to the Clinical Director Heidi Crocker by calling 757-253-1220 or emailing clinicalservices@williamsburghospice.org
