Every inpatient hospice enquiry, scored before it reaches your CRM
Ask families about the patient's current care setting, why inpatient placement is being considered, and insurance coverage, while collecting physician certification, so your team sees the full picture before it lands in your CRM.
Preview your inpatient hospice care intake
Explore 7 questions from the Inpatient Hospice Care template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified inpatient hospice care lead should tell you
Facility-based hospice care for patients whose pain, symptoms, or safety needs can no longer be managed at home, admitted once a physician has confirmed hospice-level need.
- Doctor Indicated That Patient
- Current Care Setting Patient
- Inpatient Facility Care Being
- Primary Decision-Maker Patient'S Care
- Patient Have Active Health
- Soon Inpatient Hospice Placement
- Geographic Area Should Facility
The questions your team needs answered
Every inpatient hospice care intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Has a doctor indicated that the patient has a life-limiting illness needing hospice-level care? | A confirmed physician indication of hospice-level need carries the highest weight in the catalog because it establishes the patient actually meets criteria for facility-based care. |
| What is the current care setting of the patient? | Knowing whether the patient is at home, hospitalized, in a facility, or already in hospice elsewhere tells your team what kind of transfer or admission process applies. |
| Why is inpatient facility care being considered instead of home hospice? | This single-choice answer carries the heaviest scoring weight in the catalog, since uncontrolled pain or safety concerns point to genuine facility-level need rather than general interest. |
| Who is the primary decision-maker for the patient's care? | Identifying whether a family member, power of attorney, or professional coordinator is deciding lets your team route follow-up communication and consent paperwork correctly. |
| Does the patient have active health insurance or Medicare/Medicaid coverage? | Active coverage is scored as an urgency signal because it removes the biggest administrative barrier standing between the intake and a fast admission. |
| How soon is inpatient hospice placement needed? | The urgency answer, from immediate to just planning ahead, directly determines how fast your team needs to respond once the lead lands in your CRM. |
| What geographic area should the facility search focus on? | Free-text location lets your team see immediately whether the request falls within an actual service radius before committing staff time to it. |
How Cliont scores inpatient hospice care leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Doctor Indicated That Patient: yes
- Uncontrolled pain or symptoms
- No caregiver available at home
- Safety concerns at home
- Just exploring options
- Patient Have Active Health: yes
Urgency signals
- Patient Have Active Health
- Immediately
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Inpatient Hospice Placement 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 inpatient hospice care workflows
| Cliont capability | Inpatient Hospice Care application |
|---|---|
| Conditional branching | Adjusts follow-up questions based on the current care setting answer, so a patient already in hospice elsewhere doesn't get asked the same intake path as one still at home. |
| Weighted lead scoring | Raises priority automatically when the reason for inpatient care is uncontrolled pain or safety concerns, and scores 'just exploring options' lower without discarding the lead. |
| Document upload capture | Collects physician certification of hospice eligibility and insurance documentation before the case ever reaches your CRM, so admissions isn't chasing paperwork after intake. |
| Free-text field parsing | Uses the open-ended service-area question to flag out-of-region inquiries early, before staff spend time on outreach for a facility that isn't nearby. |
| CRM routing | Sends only qualified inpatient placement requests, with urgency and decision-maker fields attached, directly into your CRM instead of a general inbox. |
Example inpatient hospice care lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Uncontrolled symptoms, urgent placement
Family cites uncontrolled pain or symptoms as the reason for inpatient care and needs placement immediately, with active insurance already confirmed—this combination scores near the top of the catalog.
No caregiver available at home
Patient is currently at home but has no caregiver present; the intake flags this reason separately from a symptom crisis and captures a within-a-week timeline for placement.
Family exploring options early
An adult child is researching inpatient hospice for a parent still hospitalized, selects 'just exploring options,' and sets no firm placement date, so the lead scores lower without being disqualified.
Insurance status unclear
Family isn't certain whether the patient has Medicare or Medicaid and needs placement within a month; the coverage question surfaces the gap early so admissions can start verification before the assessment.
Transfer from another hospice
Patient is already receiving hospice care elsewhere, but safety concerns are prompting a family to look for inpatient placement instead—current care setting and decision-maker answers route this correctly.
Connect Cliont to your workflow
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Notify your team
Email, SMS, Slack
Configure other destinations
Google Sheets, configured webhooks, Zapier and API workflows
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
Inpatient Hospice Care lead-intake FAQs
How does the intake identify urgent placement requests?
It asks how soon placement is needed—immediately, within a week, within a month, or planning ahead—and pairs that answer with the stated reason for inpatient care, so time-sensitive cases like uncontrolled pain surface first in your CRM.
What happens if a family isn't sure about insurance coverage yet?
The intake still records whatever the family knows about Medicare, Medicaid, or private coverage. Unclear or missing coverage is flagged so admissions can begin verification before the care assessment instead of during it.
Does the intake distinguish inpatient hospice requests from home hospice requests?
Yes. The current care setting question and the specific reason inpatient facility care is being considered over home hospice let your team route mismatched requests toward Home Hospice Care instead.
Who does the intake identify as the decision-maker for care?
It asks whether the patient, a family member, a legal representative or power of attorney, or a professional care coordinator is making decisions, so your team knows who to contact and what documentation to request.
Can families searching outside our service area still submit an intake?
The intake collects the geographic area the family wants the facility search focused on as free text, so staff can see immediately whether a request falls inside their coverage area before assessing it.
What if a lead hasn't received physician confirmation of hospice eligibility?
A 'no' answer to the physician confirmation question is still delivered but weighted lower than a confirmed diagnosis, giving your team the option to route the family toward a Hospice Eligibility Assessment first.
Turn inpatient hospice care visitors into qualified patients
Give every inpatient hospice care visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.