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332657 PDV forms
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hospices as of
11/10/2026 7 PM EST
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Please Note: all information you enter during this membership application process is protected by our secure webserver, which utilizes the latest encryption technology to prevent disclosure of your data to others.

Important Note About the Patient Data Vault (PDV) FREE TRIAL: If your hospice is not already an HVA member, the Patient Data Vault subscription service trial includes a temporary membership during the trial period.

New Member Registration
Hospices: A hospice is eligible for free volunteer/staff memberships once its Volunteer Coordinator (VC) becomes a member of HVA.
Volunteer Coordinators: If you are the Volunteer Coordinator for your branch office, you may sponsor all of the volunteers/staff that are under your jurisdiction at your branch. Each volunteer or staff member must complete an online application to qualify for a free membership and it will remain valid as long as your membership is active and current. Volunteers and staff will need to have your email address when applying for membership.
Volunteers/Staff: You qualify for a free membership if you are currently serving at a hospice whose Volunteer Coordinator (VC) is presently a member of HVA. To join for free, you must enter your VC's email address in the VC's Email Address field. This must be the email address your VC used when they joined HVA. Free memberships expire when your VC's membership expires.
Individuals: The HVA welcomes anyone as a member regardless of their volunteer status.

Patient Data Vault (PDV) Free-Trial Registration
Volunteers/Staff: To register for the PDV, please select FREE Membership as the type of membership then follow the remaining instructions for a FREE Membership. In order to register, your Volunteer Coordinator (VC) must have already registered and you will be required to enter VC's email address during the registration process. Your membership will expire in 60-days unless your hospice becomes a regular PDV subscriber at which time your membership will remain active as long as your VC's membership is active.
Volunteer Coordinators: To register for the PDV free-trial, please select PDV Free Trial as the type of membership then follow the remaining instructions for a paid membership. Complete the entire application. Under method of payment, select PDV Free Trial, which will provide you and your volunteers with a complimentary membership for use during the free trial period.

Please Note: If you are registering for the PDV free-trial and are not currently an HVA member, your full access to HVA membership privileges will be activated when your hospice has completed all necessary preparations and PDV operations have commenced.
Type of Membership Application:
What's the difference between the various membership options?
Required if you are applying for a free membership:
   Volunteers & Staff: To register for a free membership you must supply the email
   address of the Volunteer Coordinator/Mgr. at your hospice branch.  They must
   be a paid member of HVA and their membership must be active.
   Volunteer Coordinators: If you are a volunteer coordinator requesting a temporary
   membership for the PDV Free Trial or you are applying for a new membership,
   please do not enter your email address here.
VC's Email address:  Are we a member?
Your experience (check all that apply):
  Volunteers & Staff and Volunteer Coordinators please provide the applicable
   information in this section.
     Your Job Title:
Volunteer Coordinator/Mgr. for years (if checked, enter at least 1).
     Approximate number of Patient Care Volunteers you manage:
    
     Approximate number of Non-Patient Care Volunteers you manage:
    
Volunteer for years (if checked, enter at least 1).
Caregiver for years (if checked, enter at least 1).
No previous experience
Volunteer Coordinator/Manager Contact Information
  Please Note: If you are the Volunteer Coordinator for your hospice and you are applying
   for a paid membership then you should check the box below
  and provide your hospice email address.
I am the Volunteer Coordinator/Mgr. for my hospice branch office.
Your Hospice Email Address:
Your personal information: (all items are required)
  Please Note: We request your personal contact information so that HVA may
  continue to provide you with services if you leave your hospice or transfer to a new
  hospice. None of your information will ever be disclosed to a third party.
Title:
First Name:
Last Name:
Home Address:
City:
State                                -or-  Province
State/Province:    /   
Zip/Postal Code:
Country:
Home Phone:
Personal Email Address:

The remaining two items in this section are for Volunteer Coordinators ONLY and apply to Patient Data Vault users only:
(optional) This user is Paper Forms Submitter whose PDV forms
  will be entered into the PDV for them by a designated proxy.
Employee ID: (optional)
Hospice that you are presently serving with (if applicable):
  Volunteers & Staff: If you are applying for a free membership, you may skip this
  section.
  Volunteer Coordinators: Please enter the information for your hospice branch office.
Search Zip: 
Hospice Name:
Address:
City:
State                               -or-  Province
State/Province:    /   
Zip/Postal Code:
Country:
Hospice Phone:
Web Site Address:
This hospice provides services in (check all that apply):
  Volunteers & Staff: If you are applying for a free membership, you may skip this
  section.
  Volunteer Coordinators: Please enter the information for your hospice branch office.
Mail Preferences
 Volunteers & Staff: If you are applying for a free membership, you may skip this section.
 Volunteer Coordinators: if you prefer to have ALL regular mail and e-mail correspondence sent to you ONLY at your hospice, please indicate so below. If you do not check the boxes below, you may occasionally receive some correspondence from HVA at your home address or personal e-mail address.
 
 
How did you hear about us?
  This information is required for new memberships only.
Method of payment (please select one):
  * Required for paid memberships.
 
Please note your user name and password will be sent to you after you contact HVA via the instructions on the next screen, which will give you immediate access to the HVA "Members Only" area.
 

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