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Free hospice documentation templates

Printable visit note templates for every major hospice diagnosis — built around CMS LCD criteria so every field maps to what an ADR reviewer checks.

No sign-up required. Open a template, hit Print in your browser, and you have a structured reference for your next visit.

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LCD L34538

Dementia / Alzheimer's Disease

Use this template at every routine visit to document the specific findings that support hospice elig

13 sectionsPrintable

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LCD L34538

Cardiac Disease / Congestive Heart Failure

CHF charts live or die on specifics: daily weight trend, NYHA class, documented EF, and symptom burd

10 sectionsPrintable

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LCD L34538

Pulmonary Disease (COPD / ILD / Emphysema)

The two most common audit failures for pulmonary patients: (1) documenting dyspnea but not documenti

9 sectionsPrintable

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LCD L34538

Cancer (All Types)

Cancer charts are often the strongest in hospice — but ADRs still target them when PPS is borderline

10 sectionsPrintable

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LCD L33393

General Decline / Failure to Thrive (Non-Disease Specific)

LCD L33393 applies when no single diagnosis dominates the terminal picture — multi-morbid patients,

7 sectionsPrintable

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LCD L34538 / L33393

IDG / IDT Meeting Documentation

The IDG is the clinical and compliance backbone of every benefit period. CMS requires a meeting at l

10 sectionsPrintable

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LCD L34538 / L33393

Recertification Narrative Template

The recertification narrative is the document auditors read most carefully. Generic language and cop

8 sectionsPrintable

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LCD L34538 / L33393

Hospice Aide Care Plan

The aide care plan must be individualized, authorized by the RN, and updated at each care plan revie

10 sectionsPrintable

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LCD L34538

ALS / Motor Neuron Disease

Coming soon

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LCD L34538

Liver Disease / Cirrhosis

Coming soon

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LCD L34538

Renal Disease / CKD Stage 5

Coming soon

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LCD L34538

Stroke / Coma

Coming soon

Why these templates are structured differently

Built around the LCD, not a generic visit note

Every section maps to a specific criterion in L34538 or L33393. If a field is on the template, it's there because auditors look for it.

ADR-tested documentation language included

Each template includes sample documentation language modeled on what survives Medicare ADR review — specific, observable, connected to the criteria.

Common mistakes section per diagnosis

The most frequent charting gaps we see in denied claims are listed at the bottom of each template so you know what to double-check before filing.

Printable — no account needed

Open the template, use your browser's print function (Cmd+P / Ctrl+P), and you have a structured reference sheet. No PDF download required.

Prefer not to fill out paper forms?

NotePush generates these notes from your visit

Walk through a guided 12-step wizard that asks exactly what these templates ask — then get a complete, LCD-aligned visit note ready to paste into your EMR. Free for synthetic patients; $29/nurse/month for real-patient mode.

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