Patient Notification of Hospice Non-Covered Items, Services, & Drugs - DIGITAL FORM
Electronically Delivered eForm* - Available Now – Subscribe Today!
Briggs Digital forms:
-Updates included with annual subscription
-Form-fillable PDF documents at your fingertips
-Easy to complete on any device
UPDATED 2021
The purpose of this addendum is to notify the requesting Medicare beneficiary (or representative), in writing, of those conditions, items, services, and drugs not covered by the hospice because the hospice has determined they are unrelated to the beneficiaries terminal illness and related conditions.
Send completed License Agreements toCustomerSupport@BriggsCorp.com
*This this digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.
Delivery: Digital*
Digital/electronic merchandise & subscriptions: all digital and electronic products and subscriptions are non-refundable and non-returnable.
*This this digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.