Know which hospice referrals deserve a care assessment
The intake asks whether a physician has indicated a life-limiting condition, what the patient's current care focus is, and whether the requester holds decision-making authority, plus any physician referral or POA documentation your intake team needs before scheduling a care assessment.
The exact intake your hospice eligibility assessment leads complete
This is the real 5-question guided intake for Hospice Eligibility Assessment — the same flow your customers finish before you ever pick up the phone.
What a qualified hospice eligibility assessment lead should tell you
A guided intake that captures a physician's life-limiting determination, the patient's current care focus, and who holds decision-making authority, so hospice and palliative teams can see whether a family's situation fits their program before scheduling an in-person care assessment.
- Physician Indicated That Patient'S
- Best Describes Patient'S Current
- Requesting This Assessment
- Patient Receive Care
- Person Requesting This Have
The questions your team needs answered
Every hospice eligibility assessment intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Has a physician indicated that the patient's condition is life-limiting? | A physician's life-limiting determination is one of the two most heavily weighted answers, since it's the clinical basis for hospice eligibility. |
| Which best describes the patient's current care focus? | A comfort-focused answer scores highest because it signals the patient has already shifted away from curative treatment, the core marker of hospice readiness. |
| Who is requesting this assessment? | Knowing whether the patient, a family member, or facility staff is asking tells your team who to follow up with and what context to bring to the call. |
| Where does the patient currently receive care? | The current care setting shapes how a care assessment gets scheduled, since a home visit differs logistically from coordinating with a hospital or facility. |
| Does the person requesting this have authority to make care decisions for the patient? | Without confirmed decision-making authority, enrollment can't move forward even if the patient is clinically eligible, which is why this answer carries near-top weight. |
How Cliont scores hospice eligibility assessment leads
Every answer is weighted automatically — no manual review required.
Value signals
- Physician Indicated That Patient'S: yes
- Focused on comfort and symptom relief
- Transitioning away from curative treatment
- Not sure
- Person Requesting This Have: yes
See the lead your team receives
Hospice Eligibility Assessment Lead
From first click to qualified lead
Follow patients and caregivers through one smooth, guided flow.
They land & meet you
Your video greeting plays instantly — a real face instead of a blank form.
They explain the visit
Smart questions adapt to their visit and capture the full scope.
They share details
Symptoms, history, and documents come attached before the visit.
You get a ready lead
Scored and qualified — waiting for you to win it.
Built for hospice eligibility assessment workflows
| Cliont capability | Hospice Eligibility Assessment application |
|---|---|
| Weighted answer scoring | Scores physician life-limiting confirmation and decision-making authority higher than the requester or care-setting questions, since those two answers carry the most weight in the catalog. |
| Requester identity capture | Flags whether the assessment was requested by the patient, a family member, or a care coordinator so staff know who to contact and in what capacity. |
| Document collection on submission | Attaches a physician referral or POA documentation to the intake record so eligibility and authority can be reviewed together before scheduling. |
| CRM routing | Sends every scored hospice eligibility submission, along with care-focus and authority answers, directly to your CRM instead of a shared inbox. |
Common hospice eligibility assessment lead scenarios
Physician-confirmed, comfort-focused at home
A family member with decision-making authority reports a physician has already indicated the condition is life-limiting and care has shifted to comfort and symptom relief at home. This combination scores highest and is routed straight to your CRM for scheduling.
Facility staff requesting, authority unclear
A nursing facility coordinator submits the request on behalf of a resident transitioning away from curative treatment, but does not confirm they hold decision-making authority. The intake still captures and scores it, flagging that authority needs verification before enrollment moves forward.
Still pursuing curative treatment
A family member submits the assessment while the patient is still pursuing curative treatment and no physician has indicated a life-limiting prognosis. This scores lower under the catalog's weighting, signaling it may be premature for hospice enrollment even though the family is asking now.
Patient self-referral from hospital
The patient themselves requests the assessment while hospitalized, with a physician having already indicated a life-limiting condition and care focus shifting toward comfort. The intake surfaces this as a direct, physician-supported inquiry rather than a third-party referral.
Connect Cliont to your workflow
Send leads
HubSpot, HighLevel, Salesforce, JobNimbus
Book visits
Google Calendar, Outlook Calendar, Calendly
Notify your team
Email, SMS, Slack
Automate follow-up
Zapier, Webhooks, API
Simple, transparent pricing
Choose the plan that works for your business.
Professional
Unlimited intake forms and leads for your growing business.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Advanced analytics dashboard
Pay Per Lead
Only pay when you receive a qualified lead.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Charged only for submitted leads
More hospice and palliative care intake templates
Hospice Eligibility Assessment lead-intake FAQs
What happens if the intake shows the patient is still pursuing curative treatment?
That answer to the care-focus question carries the lowest weight in the catalog, so the lead scores lower but is still delivered to your CRM. Your team can decide whether it's a candidate for palliative care consultation instead of hospice.
Does the intake verify that the requester can legally authorize hospice enrollment?
Yes, one catalog question asks directly whether the person requesting the assessment has decision-making authority for the patient, and it's one of the two most heavily weighted answers, since enrollment can't proceed without it.
How does the intake handle requests submitted by facility staff instead of family?
The catalog captures who is requesting the assessment, whether it's the patient, a family member, or care coordinator or facility staff, so your team knows the relationship and who to follow up with, even though this field isn't itself weighted for scoring.
Can this same intake distinguish a hospice-ready lead from a palliative care consultation lead?
The care-focus question separates patients focused on comfort and symptom relief from those transitioning away from curative treatment or still pursuing it, which helps you tell hospice eligibility apart from a fit for palliative care consultation, a sibling service in your library.
What if a physician hasn't yet confirmed a life-limiting diagnosis?
The intake still accepts the submission but scores it lower, since a confirmed physician determination is one of the two most heavily weighted answers in the catalog. It won't block the lead, but it flags that clinical confirmation is still needed.
Where do qualified assessment requests end up?
Every scored submission is sent to your CRM, along with the answers on care focus, requester, care setting, and decision authority, so your intake staff have context before reaching out.
Turn hospice eligibility assessment visitors into qualified patients
Give every hospice eligibility assessment visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.