Get Transit Plus Medical Documentation Form - Milwaukee County ...

Filling out the Transit Plus Medical Documentation Form is essential for individuals seeking paratransit services provided by Milwaukee County. This guide offers a step-by-step approach to ensure the form is accurately completed online, facilitating a smooth application process.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the Transit Plus Medical Documentation Form and open it in your chosen editing tool.
2. In the first section of the form, enter the date and the treating physician’s address, telephone number, and fax number. Ensure that all contact information is correct and complete.
3. Next, provide the applicant’s name, diagnosis, and the date of diagnosis or onset of illness. This information is crucial for determining eligibility.
4. The treating physician must sign the form, indicating their name and title, alongside the date and their Wisconsin medical license number (or U-PIN). This signature is mandatory for the form to be accepted.
5. Proceed to the reverse side of the form where further questions are asked. The physician should confirm their ongoing treatment of the applicant by selecting ‘Yes’ or ‘No’.
6. If the physician selected ‘Yes’, they must indicate how long they have been treating the applicant and provide details about the last visit, including the reason for consultation.
7. The physician will then identify which diagnosis most significantly affects the applicant's ability to use public transportation. They must also assess the current severity of the relevant diagnosis as either mild, moderate, or severe.
8. Following this, the physician should describe the treatment plan for the diagnosis, noting any medications, therapies, or programs currently in use.
9. An evaluation of the effectiveness of the treatments should be written, addressing whether the applicant’s condition is under control or stable, with an explanation if necessary.
10. The final step is to complete any additional required information about hospitalizations within the last three months, documenting the reasons for such stays, if applicable.
11. Ensure both sides of the form are completed fully and signed. After completing the form, you may save your changes, download, print, or share the document as needed.

Complete the Transit Plus Medical Documentation Form online today to access the necessary paratransit services.