Written by a parent, not a doctor. Nothing here is medical advice.

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Massachusetts Department of Public Health

Pediatric Palliative Care Network

What you get

Palliative care with symptom help, counseling, care coordination, respite, and family help. Ask whether requests are open.

Who starts it
You, with a document from your doctor
How it’s sent
Online, on their website
Your time
About 15 minutes, plus waiting for the document
Last checked
Aug 27, 2026

  1. Ask your doctor for the documentStart here. This is the part that takes the longest.

    Massachusetts Department of Public Health needs a signed confirmation of the diagnosis from your doctor. It has to cover 3 things. Copy this message, or say it in person at the next visit.

    Hi [doctor’s name],

We’d like to apply to Massachusetts Department of Public Health’s Pediatric Palliative Care Network. Palliative care with symptom help, counseling, care coordination, respite, and family help. We are checking whether they are taking requests.

They need a signed confirmation of the diagnosis from you. It has to cover diagnosed condition, physician's determination that the condition could limit normal life expectancy, and delivery instructions from the serving PPCN provider. Their form and instructions are here: https://www.mass.gov/pediatric-palliative-care-network

Could you do that when you have a chance? I can send you the link, or bring a printout to our next visit. Thank you for everything you do for us.

[your name] · [phone]
    Copying is the only thing this page does with your text. Nothing is saved.

  2. Fill in their applicationIt is on their website.

    Open their application ↗ Checked Aug 27, 2026

    What the form asks for

    They don’t publish the questions in advance. Have your contact details, your child’s diagnosis and date, and the hospital’s name to hand.

  3. Submit it on their websiteSend the document with your application, or the way they ask.

    • Start by calling the Community Support Line or regional provider; then follow that provider's instructions for clinical verification and intake.

After you send

Confirm that the provider received the referral and physician statement and ask when the family will be contacted. If you have not heard back in two weeks, write and ask whether it arrived.

Full record, as published