Physician’s Medical Necessity Certification for Non-Emergency Ambulance Transports
NOTICE: It is federal mandate that ALL non-emergency transports made by ambulance must be accompanied with a Physicians Certification Statement according to 42CFR 410.40(D) (2) and (D)(3). Which assists in the determination of bed confined status and medical necessity. Upon completion and signature you must present it to the EMS personnel at the time of transport.