their communities. This may mean that some patients could be admitted to hospice car e prior to an estimated six months before death. However, care must be taken to certify patients for the Benefit only when it is reasonable to conclude that their prognosis is six months or less. In other cases alternative modes of reimbursement, often provided through community support, can be sought outside the Medicare Hospice Benefit. Emphasis should be placed on evaluating the whole person and the entirety of the illness. It is important to note, for example, that a patient may have multiple medical problems, none of which individually amount to a terminal diagnosis , but when taken together indicate a terminal condition . In short, clinical judgment that takes both medical and nonmedical factors into account is necessary for accurate estimation of prognosis. Potential Limitations Several caveats are in order when using these Guidelines for prognostic purposes. They are a first attempt at extrapolating a large amount of heterogeneous evidence from many studies to predict survival in non-cancer diseases (see Appendix I ). Their accuracy will need to be validated by further research. These Guidelines should be applied to individual cases very cautiously, for at least the following reasons: Many of the studies referenced here indicate an increased likelihood of death , sometimes within an uncertain time frame. The six month definition of terminal illness adopted for the Medicare Hospice Benefit has rarely been used as a specific outcome measure in most of this research.