Caregiver Notification Form
At a Hospice, Hospital, Care Facility, or Residence:
When a death occurs at a hospice, hospital or care facility, please ask the staff to notify us by phone. When a death occurs at a residence, you or a health care provider can notify us by phone.
Prior to a death, use this Caregiver Notification Form to ensure the health care provider has the proper information on file so we are notified in a timely manner.