Get Logisticare Transportation Delaware

Filling out the Logisticare Transportation Delaware form is an essential step in ensuring that individuals receive the appropriate transport services. This guide will provide clear instructions on how to accurately complete the form, ensuring a smooth process.

Follow the steps to fill out the Logisticare Transportation Delaware form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the member's name and date of birth in the designated fields. Ensure that the provided information is accurate.
3. Input the member's Medicaid number in the provided section. This is crucial for identification and processing.
4. Answer the questions regarding the member's mobility and medical needs by checking the appropriate boxes. Indicate if the member requires a wheelchair, can transfer, needs medical monitoring, or requires oxygen.
5. Select the mode of transportation required by checking the relevant option. Options include 'Ambulatory', 'Wheelchair Van', 'Van Stretcher', or 'Stretcher'.
6. If applicable, provide the qualifying ICD9 code or diagnosis for the requested transportation mode.
7. Include any comments that might be pertinent to the transport needs of the member in the comments section.
8. The form must be signed and printed by the professional completing it. Indicate their name, title, and facility information, along with the date of completion.
9. After filling out all necessary fields, save the changes made to the form. You may also download, print, or share the form as needed.

Complete the Logisticare Transportation Delaware form online to ensure timely and appropriate transport for the member.