Wis. ForwardHealth Online Handbook, Hospice, Topic #1174

A written POC (plan of care) must be established for members who elect to receive hospice services before hospice care is

provided. The POC should be kept in the member's record and should not be sent to ForwardHealth.

The attending physician, the medical director or physician designee, and the interdisciplinary team must establish the POC. The

POC must include:

• An assessment of the needs of the member.

• The identification of services to be provided, including management of discomfort and symptom relief.

• A description of the scope and frequency of services to the member and the member's family.

• A schedule for periodic review (at least every two weeks) and updating of the POC (as needed), evidenced by the

physician's signature and date.

If the physician's signature on the POC is stamped, both of the following requirements must be met:

• The hospice provider must obtain a dated statement from the physician with the physician's original signature attesting that

they are the only person who possesses the signature stamp and are the only person who uses it.

• The hospice provider must maintain the signed and dated physician statement in the hospice's records.