HOME VISITING HUB

Pilgrims Hospice Society is pleased to launch our Home Visiting Hub Program, which now includes Home Visits from Primary Palliative Care Physicians. This service is intended to bridge the gap for those living with a life threatening progressive illness at home who do not have access to a primary care provider.

* Required Fields
Referral for Physician Home Visiting Form:
Name of Person Making the Referral*
First Last
Your Email*
Phone*
Client's Name*
First Last
Date of Birth (MM/DD/YYYY)*
MM slash DD slash YYYY
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone*
Emergency Contact Name
First Last
Emergency Contact Phone
Primary Diagnosis*
Reason for Referral*
Alberta Healthcare Number (PHN)*
Goals of Care Designation*
Social Situation*
Palliative Blue Cross*
- Yes
- No
Current Primary Care Practitioner

(If Applicable)
Security Check
Name
This field is for validation purposes and should be left unchanged.

Contact US

When contacting us, be prepared to leave a message and will return your call based on urgency. Please make sure to have the following:

Name of community client you are calling about
Name of your Primary Palliative Care Physician
Your name, number and relation to client.
Reason for your call – please be as specific as possible

Referral calls will be returned within 2 business days. Calls regarding current patients will be returned within 1 business day, or more quickly if the call is urgent – see examples below.

Examples of non-urgent calls: rescheduling an appointment, non-urgent prescription renewal, message for physician, minor change in health status, expected death in the home.

Examples of Urgent calls: pain crisis that has not improved with breakthrough medications, sudden change in consciousness, uncontrolled symptoms, severe discomfort.

Contact us:
Phone: 587-415-3537
Email: homevisits@pilgrimshospice.com

HOME VISITING HUB

Referral for Physician Home Visiting Form:

Contact US