useful forms and documentation
downloads
Here at Advanced Medical Transport, we know that it can be a time-consuming process to find and fill out patient related forms. That's why we've supplied links below to a few of our most commonly requsted forms so that you can fill them out at your convenience. Please don't hesitate to contact us with any questions you may have.
billing
This program provides discounts on transportation charges for patients that meet pre-determined household income and family size requirements.
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Proceso de solicitud para el Programa de asistencia financiera
Medicaid / medicare
MEDICARE Physician Certification Statement
The Physician Certification Statement (PCS) Form is 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.
MEDICAID Transportation Requirements
Not all ambulance service is covered by Medicare. In order to be covered, the ambulance service must be necessary and reasonable.
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MEDICARE Transportation Requirements
Not all ambulance service is covered by Medicare. In order to be covered, the ambulance service must be necessary and reasonable.
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IPT Transport Request
Behavior Health Service Transport Request Form
Illinois Patient Transport (IPT), transports involuntary patients, regardless of a client’s ability to pay. Involuntary transports are funded when utilizing Illinois Patient Transport, through a contract with the Illinois Department of Human Services.
To request a transport, FAX the following documents to 309-494-6227:
- Petition & Certificate (or Court Order)
- Hospital Face Sheet
- Illinois Patient Transport Request Form
Transportation for voluntary and juvenile patients (12 and older) may be arranged on a case by case basis with a guarantee of payment or, for a better rate, your facility may wish to contract directly with Illinois Patient Transport.