What Documents Do You Need to Start Hospice?

To start hospice you mostly need to gather a few everyday items: the patient's insurance or Medicare card, a photo ID, a current medication list, and any advance directives. The hospice itself obtains the medical certification of eligibility from the physicians. The paperwork is lighter than most families expect, and the hospice walks you through it at intake.

What you bring

• Insurance cards: the Medicare card, Medicaid card if applicable, or private insurance and Medicare Advantage cards. This lets the hospice verify the benefit.
• Photo ID for the patient (and often for the legal decision-maker).
• Current medication list: names, doses, and how often each is taken, plus the pharmacy you use. Bring the actual bottles if a written list is not handy.
• Advance directives: living will, healthcare power of attorney, POLST/MOLST, and any DNR order if one exists. See our guide on advance directives and hospice. Note that hospice does not require a DNR.
• Legal authority documents: if the patient cannot sign for themselves, bring the durable power of attorney or guardianship paperwork showing who may consent.
• Allergy list and the names of current doctors, so the team can coordinate care.

What the hospice handles, not you

Families often worry about obtaining medical records or proving eligibility. You generally do not have to. The hospice obtains:

• The physician certification of terminal illness, a written statement from the hospice physician (and usually the attending physician) that the patient has a prognosis of six months or less if the illness runs its normal course. This is a clinical judgment, not a form families fill out.
• Relevant medical records from the hospital or treating doctors, with your signed release.

What you sign at admission

The central document is the hospice election statement, in which the patient (or their legal representative) chooses the Medicare hospice benefit and the specific hospice provider. Our guide on the hospice election statement explains exactly what you are agreeing to. You will also sign consent for care, a financial/insurance acknowledgment, a privacy notice, and a release of medical information. These are completed during the intake visit on day one.

The election statement, in plain terms

The election statement is the one document worth understanding before you sign. By electing the Medicare hospice benefit, you are choosing comfort-focused care for the terminal illness and agreeing that, for that illness, you waive standard Medicare payment for treatment aimed at curing it. Care for conditions unrelated to the terminal diagnosis continues through regular Medicare. The statement also names the specific hospice you have chosen and acknowledges that you can change providers once per benefit period and can revoke (leave) hospice at any time to return to standard coverage. It does not lock you in, and it does not require a DNR. If anything on the form is unclear, ask the admitting nurse or social worker to walk you through each section before you sign — that is part of their job.

Who can sign if the patient cannot

When a patient is too ill or cognitively impaired to sign, a legal representative signs on their behalf. Who that is depends on your documents and your state's rules. Most often it is the person named in a durable healthcare power of attorney (sometimes called a healthcare proxy or agent). If no such document exists, a court-appointed guardian or, in some states, a default surrogate (typically the spouse, then adult children) may sign. Bring whatever authority paperwork you have so the hospice can confirm who is permitted to consent. If nobody has clear authority, the hospice social worker can help sort out the right path quickly so care is not delayed.

If documents are missing

Do not let a missing form delay comfort care. Hospices admit patients every day without a complete folder. If there is no advance directive, the team's social worker can help create one. If you cannot find an insurance card, the hospice can usually verify coverage by other means. The goal at admission is starting symptom relief, not perfect paperwork.

You provide	Hospice provides
Insurance cards, ID	Physician certification of prognosis
Medication and allergy list	Medical records release and retrieval
Advance directives (if any)	Election statement and consent forms
POA/guardianship (if applicable)	Plan of care

How documents differ by setting and payer

The core list above holds wherever the patient lives, but a few details shift by situation. If the patient is in a nursing home or assisted living, the facility and hospice coordinate a written agreement, and you may sign additional coordination consents; the hospice covers the hospice services while room and board is handled separately (Medicaid may cover the nursing-home bed for dual-eligibles in participating states). If the patient has Medicare Advantage, you elect the hospice benefit through original Medicare and bring the Advantage card so the plan is notified. For VA enrollees, bring VA enrollment information so benefits can be coordinated. With private insurance, the hospice verifies the specific plan's hospice terms, which can vary. When you are moving directly from a hospital, the discharge planner often forwards records to the hospice before you arrive, which speeds things up.

Frequently asked questions

Do I need a DNR to start hospice?

No. Hospice does not require a Do Not Resuscitate order. Code status is a separate choice you discuss with the team; many patients enroll without a DNR. See advance directives and hospice.

Do I have to prove my loved one qualifies?

No. Eligibility is a physician's certification of a terminal prognosis, supported by the medical record the hospice gathers. Families do not fill out an eligibility form or score a scale themselves. If you are unsure whether your loved one is eligible, request a free hospice evaluation.

Can we start the same day?

Often yes. If the physician certification and election statement are completed and a plan of care is begun, admission can happen the day you decide, sometimes within hours. Missing paperwork rarely has to delay symptom relief.

What if there is no advance directive at all?

You can still enroll. The hospice social worker can help create a living will or healthcare power of attorney after admission. The absence of these documents does not stop care from beginning.

Who keeps the original documents?

You keep your originals; the hospice makes copies for the chart. Keep advance directives, the election statement copy, and the 24-hour phone number together in one folder at home so everyone in the family can find them.

Your practical next step

Gather the items above into one folder before the admission visit so the nurse can focus on care, not searching. If you have not enrolled yet, our guide on how to enroll a loved one in hospice covers the full process, and you can compare hospices near you on quality scores before choosing a provider. If you are unsure whether your loved one is eligible, request a free hospice evaluation first.