Patients & Family Members Medicare

Forms & Documents – Patients & Family Members Medicare

Elite Ambulance Physician’s Certification Statement (PCS)

Written authorization from a physician, physician’s assistant, nurse practitioner, clinical nurse specialist, discharge planner, or registered nurse signifying that transport by ambulance is medically necessary and the patient’s condition at the time of transport meets medical necessity requirements. For an ongoing patient (multiple trips), the PCS must be signed by a physician.

Medicare Ambulance Guidelines for Medical Necessity

Medicare Ambulance Guidelines for Medical Necessity

Medical necessity is established when the patient’s condition is such that using any other transportation method would be hazardous to the patient’s health. This document outlines conditions to be met for medical necessity and provides a table reflecting different origination points and coverage.

Medicare Beneficiary Signature

Medicare Beneficiary Signature

The form is used to advise Medicare of the person you have chosen to access your personal health information.

Medicare Coverage of Ambulance Services Booklet

Medicare Coverage of Ambulance Services Booklet

Booklet from the Department of Health and Human Services explains Medicare’s ambulance transportation coverage, paying for ambulance services, Medicare Rights & Protections, and definitions.

Medicare and You – 2021

Medicare and You – 2021

The extensive official U.S. government Medicare handbook (152 pages) explains all aspects of Medicare, enrollment, coverages, patient rights and fraud protection, long-term care, and obtaining more information and definitions.

Medicaid

Medicaid Ambulance and Medicar Coverage Guidelines

The document provides guidelines for ambulance and MediCar coverages by Medicaid, including prior approvals, approval procedures, and a table reflecting different origination points and coverage.

Other Helpful Forms & Documents

Privacy Practices Notice

Elite Ambulance’s notice describes how medical information about you may be used and disclosed and how you can get access to this information.