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Member Profile

Keeping our records accurate and up-to-date is paramount in ensuring timely, efficient communication with valued members. Thank you for helping us serve you better by updating your profile each year.

Organization*
Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address (If different than physical address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Website
800 # (If applicable)
Fax
Primary Contact Person for TNMHO Member Account*
Who should we ask for if questions come up about your TNMHO member account?
First Last
Primary Email for TNMHO Member Account*
Preferred Email for Hospice Locator Page (intake)
If your organization uses a specific email address for patient intake, let us know and we will post this email address on your hospice locator page.
PEOPLE
Key Staff List
Keep your staff in the loop on trainings, conferences, and hospice news from TNMHO! When discipline-specific training and events come up, we will forward information directly to the appropriate staffer. (i.e. We Honor Veterans, chaplain training, billing conference, regulatory conference, etc.) We are happy to save administrators from endless email forwarding. You're welcome! Use the + button to add up to eight staff contacts.
Name Title Email
SERVICE AREA
Counties Served
Please list each county served by your organization, in alphabetical order. Avoid listing service area by regions, please, as the hospice locator tool relies on the county list. Thank you!
ORGANIZATIONAL STRUCTURE
Organization Details
We want to better understand and effectively segment our membership. Please check all the apply:
- Operational
- Developing
- For-profit
- Nonprofit
- Primary Licensed Site
- Alternate Delivery Site
- Stand Alone (independent)
- Hospital-based
- Medicare Certified
- Medicaid Certified
- Inpatient Facility
- NHPCO Member
Accredited by:
Start Date of Operations
DUES
Member Dues: Billing Preference
Members have a choice in how to submit member dues:
- Bill us via e-Invoice *
- We will add membership to our account and pay out via the shopping cart
- We are mailing a check
* Annual Patient Revenue (If requesting e-Invoice)
To pay by card from an e-invoice please provide your Annual Patient Revenue for the last 12 months. We will calculate dues based on gross APR x .0007, and issue the e-invoice.
Membership Plus
Train your whole staff - accessible all year - from our extensive online library. There's something for each hospice discipline. Membership Plus is just $550 + 10% of annual dues. To multi-site providers to qualify for Membership Plus, each location with a different Medicare number (within the states of Texas or New Mexico) must be a member. Please note that Membership Plus subscription pricing is per location. For more information paste this link into a new tab of your browser: https://www.txnmhospice.org/education/ Check the box below to add Membership Plus to your e-invoice!
- YES! Please add Membership Plus online education access to our account!
Email for Member Dues Invoice
Let us know where to send your e-invoice for member dues:
Note to TNMHO Membership Staff:
Any additional information you want us to be aware of? Feel free to share it here. ***If your membership includes Alternate Delivery Sites (billed under the same Medicare number) please note those addresses below so that we can include them on our hospice locator tool.*** Thank you!
Phone
This field is for validation purposes and should be left unchanged.

THANK YOU for being part of the TNMHO member community.

Name	Title	Email

Member Profile

PEOPLE

SERVICE AREA

ORGANIZATIONAL STRUCTURE

DUES