Joliet Area Community Hospice
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Joliet Area Community Hospice

Referral Information

Individuals are referred to Hospice from a number of sources. Patients are usually referred to hospice services by the primary physician.

Referrals can also be made by patients, family members, friends, clergy or health care professionals. The primary physician is then contacted regarding an order for the hospice services.  Joliet Area Community Hospice provides services to children and adults; ages 0 to 100+.

At any time during a life-limiting illness, it’s appropriate to discuss all of a patient’s care options, including hospice. The earlier a patient is referred to hospice services, when comfort care rather than aggressive treatment is the choice, the greater the benefit not only to the patient but also to family.

Please contact us at (815) 740-4104 or (800) 360-1817 for information or referrals, or complete the online Referral Form below.

Referrals and admissions may be made at any time by calling (815) 740-4104. Referrals via e-mail will be received between the hours of 8-4:30 p.m., Monday through Friday.

Complete online form below and submit and a Hospice staff member will contact you.

Who is completing this form?

Patient
Healthcare professional
Family
Friend

Type of Referral

Hospice

Patient Information

Last name:
First name:
Middle initial:
Sex: Male Female
City:
County:
Patient's phone number:
Caregiver name:
Caregiver phone number:
Primary physician:
Physician's phone:
Admitting diagnosis:
Any special concerns:
Where is the patient now?
Your name:
Your phone number:
Your relationship: Hospital Physician Family
Nursing facility Other
If FAMILY, how are you related?
Who do we contact for more info?
 
 
 
Call Joliet Area Community Hospice at 800-360-1817