Refer A Patient

As a healthcare partner, we value your referrals. Patients are admitted 7 days a week, 24 hours a day. To begin the referral process, please fax the patient’s facesheet and medical records to (209) 541-3292 and complete the form below.

 For questions, please call the Community Hospice Care Services Department at (209) 578-6340.

Case manager and Physician Office Referral Form

Fields marked with an * are required

Please complete the form below to refer a patient to Community Hospice.

By clicking “SEND” you acknowledge to be over 18 years of age or older and that you have been notified of Community Hospice’s Privacy Notice.