I understand that I may revoke the Election of The Medicare Hospice Benefit and choose to do so at this time. I choose to revoke use of the Medicare Hospice Benefit for the remainder of this benefit period and will return to the Medicare health care benefits I waived to receive hospice care.
I understand that I may be readmitted to hospice care at a later date, provided, that the admission criteria are met and that I have a viable hospice benefit.