HOPE Guidance Manual v1.02, Item Z0400

Timepoint(s) Item Completed

Admission (ADM)

HOPE Update Visit 1 (HUV1)

HOPE Update Visit 2 (HUV2)

Discharge (DC)

Item-Specific Instructions

• Signatures in Z0400 should reflect those hospice staff members who completed HOPE, which may or

may not be the clinician who completed care processes documented in the clinical record. Signatures

may be electronic.

• All staff who complete any part of the HOPE record shall enter their signature, title, section, or

portion(s) of a section(s) they completed, as well as the date completed.

o If an individual completes multiple sections of HOPE, that individual can sign once in Z0400 and

indicate which sections they completed in the “Sections” portion of Z0400.

o One or more staff members can complete items within the same section of the HOPE record. When

filling in the information for Z0400, any staff member who has completed a portion of a section

should identify which item(s) he or she completed within that section.

o If a staff member cannot sign and date Z0400 on the same day that he or she completed a section or

portion of a section of the HOPE record, that staff member should enter the original date of HOPE

record completion when signing Z0400.

o The hospice is responsible for the accuracy of all items on HOPE, irrespective of how they are

completed or auto-populated in the HOPE record.

• Read the Attestation Statement carefully. Persons signing Z0400 are certifying that the information in

the HOPE record, to the best of their knowledge, most accurately reflects documentation in the patient’s

clinical record.

Coding Tips

• Z0400 is not submitted as part of the HOPE record; developing internal policies and procedures for

completing and archiving Z0400 is up to the discretion of the hospice.

• This signature-block section (Z0400) is provided for use by the hospice, and it is suggested that it be

retained at the hospice in accordance with policies and procedures related to patient information.