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Run: Hospice Continuous Home Care Crisis Documentation

Hospice Continuous Home Care Crisis Documentation captures the crisis episode, nursing interventions, time spent, and the billing justification needed to sup...

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Crisis Episode Overview

Patient Identifier (required)

Use the medical record number or other internal identifier. Do not enter full SSN or other unnecessary PII.

Date of Crisis Episode (required)

Crisis Start Time (required)

Crisis End Time (required)

Document the end of the crisis period or nursing coverage window.

Primary Crisis Trigger (required)

Brief Crisis Summary (required)

Describe the acute change, symptoms observed, and why the situation required continuous nursing intervention.

Nursing Care Provided

Nursing Interventions Provided (required)

Medications Administered During Crisis

List only medications relevant to the crisis period and the response observed. Avoid unnecessary detail.

Patient Response to Nursing Care (required)

Document whether symptoms improved, remained unstable, or required ongoing intervention.

Other Disciplines Involved

CHC Billing Justification

Total Hours of Nursing Care in 24 Hours (required)

Enter the total nursing care hours provided during the 24-hour period. CHC generally requires at least 8 hours of predominantly nursing care.

Was the care predominantly nursing care? (required)

Select Yes only if the documented care was primarily skilled nursing rather than custodial support.

Does this episode meet the CHC threshold? (required)

Use this field to indicate whether the documentation supports CHC billing criteria.

Billing Justification Narrative (required)

Explain why continuous home care was necessary, including the crisis nature of the episode, the nursing intensity, and the clinical need for continuous presence.

Attestation and Submission

Documented By (required)

Role (required)

Attestation (required)

Yes No N/A

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