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F0849
D

Failure to Obtain Required Hospice Election Form

Hollidaysburg, Pennsylvania Survey Completed on 11-20-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that the designated interdisciplinary team member obtained the required hospice benefit of elections form from the contracted hospice provider for one of five hospice residents reviewed. The agreement between the facility and the hospice provider specified that the hospice provider would supply information, including the benefit of elections form, to facilitate coordination of care. Physician's orders indicated that the resident was to receive hospice services, but as of the date of review, there was no documented evidence in either the facility's or the hospice provider's clinical records that the form had been obtained. Interviews with the Social Service Manager and the Hospice Representative confirmed the absence of the required documentation in the resident's hospice chart.

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