ResolutionCare SelfAssessment

At ResolutionCare we work with your existing medical team and caregivers to provide an extra layer of human-centered support when you or your loved ones are facing serious illness. If you have Blue Shield of California, Partnership HealthPlan, HealthNet, or another non-Medicare plan with a full palliative benefit you may qualify for our services.

Take the short self assessment below to see if you, or those in your care, may qualify for palliative care.

1. Funding (insurance coverage) of home-based palliative care with a specially trained team depends on your health plan.
Do you, or the person in your care, have one of the following options? *This question is required.

Blue Shield of California as primary health insurance (non, self-funded plans)
Partnership HealthPlan (PHP) of California
HealthNet (California Health & Wellness)
Another Medi-Cal managed care plan, in California
Other health plan with a full, palliative care benefit
Ability and willingness to self-pay
None of the above
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

2. Palliative care is provided to people who have a serious illness. Have you or the person you are caring for been diagnosed with a serious illness. Have you or the person you care for been diagnosed with any of the following (select all the apply):

Advanced Dementia
Advanced Cancer
End Stage Renal Disease
Advanced COPD
Advanced Heart Failure
End Stage Liver Disease
Other - Life Limiting Illness (write-in) Please enter an 'other' value for this selection.
None of the above

2. Have you, or the person in your care, experienced the following as a result of a serious illness? (check all that apply)

An emergency room or hospitalization visit within the last 6 months
Uncontrolled symptoms such as pain, shortness of breath, constipation leading to an Emergency Department Visit
Less ability to handle daily activities without help
Uncertainty or distress
Other - Write In Please enter an 'other' value for this selection.
None of the above

2. Palliative care is provided to people who have a serious illness. Have you or the person you are caring for been diagnosed with a serious. Have you or the person you care for been diagnosed with any of the following (select all the apply):

Cancer: Locally advanced or metastatic cancer; leukemia or lymphoma
Congestive heart failure
Chronic obstructive pulmonary disease
Cerebral vascular accident/stroke: Inability to take oral nutrition, change in mental status, history of aspiration or aspiration pneumonia
Chronic kidney disease (CKD) or End Stage Renal Disease (ESRD)
End-stage liver disease (ESLD)
Severe Dementia or Alzheimer’s Disease
Other - Write In Please enter an 'other' value for this selection.

2. Have you, or the person in your care, experienced the following as a result of a serious illness? (check all that apply)

One or more ER visits within past 12 months
One or more hospitalizations within past 12 months
Hospital readmission within past 30 days
Current referral prompted by: Uncontrolled symptoms related to underlying disease (e.g., pain, shortness of breath, vomiting) AND/OR Inadequate home, social, family support
None of the above

2. ResolutionCare provides services through video chat. Do you, or the person in your care, have access to high speed internet?

ResolutionCare SelfAssessment

Self Assessment