Get H: Ma Transportation Forms Provider Certfication Ambulatory & Wc ... - Baltimorehealth

Filling out the H: MA Transportation Forms Provider Certification for Ambulatory and Wheelchair transports is essential for ensuring patients receive the necessary medical transportation services. This guide will help you navigate through the form, highlighting key fields and offering detailed instructions for each section to facilitate a smooth application process.

Follow the steps to complete the transportation forms accurately

1. Press the ‘Get Form’ button to acquire the H: MA Transportation Forms Provider Certification Ambulatory & WC. This will allow you to open the document and begin the completion process.
2. In Section 1, enter the patient's personal information, including their last name, first name, address, and contact phone number. If applicable, include the facility name and room or bed number. Ensure to provide the Medical Assistance and Medicare numbers if available.
3. Move to Section 2 where the healthcare provider must complete the patient's medical information. Fill out primary and secondary diagnoses, listing associated symptoms without using ICD or DSM codes. Include the patient's weight and height, and check any relevant conditions affecting transport.
4. In Section 3, record the type of medical service for which the patient is being transported. Specify the duration and frequency of appointments as applicable. This information is vital to determine transportation eligibility.
5. Proceed to Section 4 to certify the mode of transportation required. Indicators such as whether the patient can ambulate and the type of wheelchair (if applicable) must be clarified. Ensure that any necessary accompaniment during transport is indicated.
6. Complete the provider certification at the end of the form, which must be signed by a physician, certified nurse practitioner, or dentist. Include the provider's contact information and Medical Assistance or NPI number. This step is crucial to validate the medical necessity of the provided information.
7. Once the form is filled out completely, save any changes and download or print the document. You may also share the completed form as needed.

Complete the H: MA Transportation Forms Provider Certification Ambulatory & WC online to ensure timely transportation services for patients.