Rosenthal Community Care Services
NOTIFICATION OF HOSPICE INTERRUPTION OR BEING DISCONTINUED OTHER THAN DEATH
NOTIFICATION OF HOSPICE INTERRUPTION OR BEING DISCONTINUED OTHER THAN DEATH
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Notification of Hospice Interruption
Professional RCFE & Assisted Living Documentation Form
Ensure your facility remains compliant and organized when critical changes occur in a resident's care plan. The Notification of Hospice Interruption or Discontinuation (Other Than Death) form is a structured, professional document designed specifically for RCFEs, board and care, and assisted living environments to formally report and record when hospice services are halted.
Organized Form Sections
Resident & Event Details
Capture crucial resident data, admission dates, administrator information, and detailed event documentation.
Hospice & Physician Info
Designated fields for the hospice agency's contact details, address, and the attending physician's information.
Timeline Reminders
Built-in indicators tracking the 1-day telephone report and 5-day written report deadlines.
Document Confirmation
Checklists to verify that written reports are attached and all supporting information is securely organized.
Reporting Timeline Guidance
Navigating hospice service changes requires strict adherence to state reporting procedures. This editable Word document is structured to help your facility safely track these mandatory California RCFE deadlines while allowing you to seamlessly integrate your own facility branding.
Critical Deadlines to Track:
1. Telephone Report: Report the interruption or discontinuation to the Department by telephone within one (1) working day.
2. Written Report: Submit the written report with the required resident, event, and hospice follow-up information within five (5) working days.
Instant Digital Download | Editable Word Document
No physical product will be shipped. After purchase, you will immediately receive a link to download your fully editable Word file.
Important Compliance Notice: This template provides administrative and documentation support to organize records and events. The document does not guarantee regulatory compliance or acceptance by a licensing, hospice, medical, or government authority. Facilities remain responsible to confirm and follow current reporting requirements in their jurisdiction.
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