Get Iehp Transportation

The Iehp Transportation form is essential for arranging medical transportation for individuals with specific needs. This guide provides a detailed, step-by-step overview on how to complete the form online, ensuring that all necessary information is accurately reported.

Follow the steps to complete the Iehp Transportation form effectively.

1. Click ‘Get Form’ button to obtain the transportation request form and open it for completion.
2. Enter today’s date in the provided field to indicate when you are submitting the request.
3. Fill in the discharge date and time if applicable, ensuring it aligns with the required transportation schedule.
4. In the NAME field, input the full name of the person requiring transportation.
5. Enter the IEHP ID# to facilitate the identification and services related to the individual.
6. If the member is using a wheelchair or gurney, provide their height and weight in the respective fields.
7. Indicate any special needs such as tracheostomy to ventilator requirements or suctioning if necessary.
8. Specify if oxygen is needed by selecting 'Yes' or 'No', and complete the liter flow needed (deep, mild, shallow).
9. Provide any additional comments in the comments section for further clarification.
10. In the transportation from section, fill out the facility name, room number, address, city, and zip code.
11. Include the name and phone number of the contact person at the originating facility.
12. In the transportation to section, enter the destination facility name (if applicable), room number, address, phone number, city, and zip code.
13. For follow-up appointments, check all relevant services such as dialysis, chemotherapy/radiation, or other, and fill in the appointment date, dialysis days, and appointment time.
14. Indicate the mode of transport required by selecting from the options: ambulatory, wheelchair (specifying if bariatric or standard), gurney, or care attendant.
15. Once all fields are completed, review the form for accuracy. You can then save your changes, download, print, or share the completed request.

Start filling out the Iehp Transportation form online to ensure timely and appropriate medical transportation.