Provider Patient Referral

Please fax Face Sheet and H&P to (432)682-2989 if you can't attach documents below. If submitting after 5 pm we will contact you next business day.

Hospice of Midland Instant Referral

Patient's Name*

Patient's Phone Number*

Email*

Patient's Date of Birth

Healthcare Provider's Name

Provider's Phone Number

Attach Face Sheet and H&P

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How to Refer a Patient

A simple phone call to Hospice of Midland (432) 682-2855 will initiate the admission process.

Then, Hospice of Midland will contact the patient's physician to discuss disease progress and appropriateness for hospice services. Afterward, an appointment will be scheduled with the patient and family to further evaluate the patient’s needs and discuss hospice services.

Service Area

Ector County, Glasscock County, Martin County, Midland County, and Upton County.

Affiliates

National Hospice and Palliative Care Organization

Member of Texas & New Mexico Hospice Organization

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