Get Swems,inc Physician Certification Statement For Non ...

This guide provides a detailed, step-by-step approach to completing the SWEMS,INC Physician Certification Statement for Non-Emergency Ambulance Services online. By following these instructions, users will ensure accurate certification for necessary patient transport.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in a digital editor.
2. Enter the patient's full name and transport date in the designated fields at the top of the form.
3. Fill in the patient's date of birth and Medicare number, ensuring these details are accurate as they are critical for processing.
4. Specify the origin and destination of the transport.
5. Indicate whether the patient’s stay is covered under Medicare Part A by selecting ‘YES’ or ‘NO’.
6. Identify if the closest appropriate facility is being used by selecting ‘YES’ or ‘NO’. If ‘NO’, provide a brief explanation in the designated area.
7. For hospital to hospital transfers, describe the services needed at the second facility that are not available at the first.
8. If the patient is in hospice care, indicate if the transport is related to the patient’s terminal illness and provide a description if applicable.
9. In Section II, describe the medical condition of the patient at the time of transport and explain why other means of transport are contraindicated.
10. Answer the questions regarding whether the patient is ‘bed confined’ and if they can be safely transported by car or wheelchair van.
11. Check any additional conditions that apply to the patient, noting that supporting documentation must be retained in the patient's medical records.
12. In Section III, the physician must carefully read the certification statement, then provide their signature and the date signed.
13. Ensure the printed name and credentials of the physician are filled in accurately. Remember that only the attending physician can sign this form.
14. Review all filled out sections for accuracy before proceeding. You can save changes, download, print, or share the form as needed.

Complete your SWEMS,INC Physician Certification Statement online today for efficient patient transport!