Your volunteer hours are very important to this organization. Seacoast Hospice is a Medicare-funded agency and our funding requires that 5% of our total patient care hours be provided by volunteers. Only your reported hours can be recorded and counted toward this requirement. For a printable version of this timesheet that volunteers may mail Click Here.

All paper timesheets may be mailed to the Volunteer Coordinator at Seacoast Hospice 10 Hampton Road Exeter, NH 03833.

Please note: A red asterisk indicates the information on the form below is required for sending. It is important that only one patient is addressed per timesheet. Multiple visits with one patient may be listed on one timesheet, however multiple patients cannot.



Volunteer's Title* and Name* (Please be sure to check off one of the title selections):

  Mr. Ms. Mrs. Miss   

Volunteer's Email*:

 
KEY TO TOTAL HOURS
1-15 minutes…….. .25
16-30 minutes…… .50
31-45 minutes…….. .75
46-60 minutes…… 1.00
61 - 1 hr 15 min…… 1.25
1 hr 16 min - 1 hr 30 min….1.50
1 hr 31 min - 1 hr and 45 min…… 1.75
1 hr 46 min - 2 hours…...2.00

Travel Time:

Beacon Hospice reimburses mileage traveled by volunteers for Beacon Hospice duties more than 10-15 miles from your home. This is your responsibility to fill out and submit.  Please note that emails will not be accepted in lieu of this form.

Mileage should be counted from your home location to point of service and will be reimbursed at a rate of $.45 per mile.

All forms should be mailed to:  Volunteer Coordinator at Seacoast Hospice, 10 Hampton Rd. Exeter, NH 03833.  These need to be mailed once a month and are processed on a monthly basis. Reimbursement usually takes 4 weeks. NOTE: Travel time cannot be counted on your timesheet.  Click Here for mileage reimbursement form.

Patient Notes: 

Medicare requires that for every direct care visit you make you also must include a sentence about your observations of that patient.

The answers to the following questions are required for each patient visit:

• What do you do during your visit? (i.e. Companionship, friendly visit, calm presence, sitting vigil, complimentary therapy or patient refused or unavailable)
• Specific Interventions performed, if any? (i.e. Reiki, music, pet therapy)
• Was the patient satisfied with the visit? Please include any additional notes or observations.
• Did the patient indicate any pain or discomfort? If yes, please describe.  *Note: If pain or discomfort indicated notify Beacon staff at 1-800-HOSPICE as well as facility staff (if applicable).
• When do you plan to visit the patient again? Please list specific date. If you are unable to fulfill this appointment please contact the Volunteer Coordinator at 603-778-7391.
 

 Notes/Comments:

By hitting send I certify that this timesheet and notes included are accurate to the best of my abilities and serves as my electronic signature.

Thank you for reporting your timesheet within 24 hours of your service!