Election Statement

Each hospice agency designs its own election statement, which should include the following elements:

• Identification of the particular hospice agency to provide the care
• A statement describing the hospice program
• Member's acknowledgment of full understanding
• Effective date
• Signature of member or guardian
• A statement explaining the member may revoke hospice services at any time
• Requirements for hospice care

The member is required to elect hospice care and the attending physician is required to establish a plan of care before services are provided.

According to AB 1299 (ch. 825, 2004), certain preliminary and palliative services prior to the election of hospice services can be provided. Refer to the Prior to Election of Hospice Services discussion found under the Hospice topic.