Get Oh Jfs 01960 2003-2026

Filling out the OH JFS 01960 form is an essential step in certifying the medical necessity for ambulance transportation in Ohio. This guide provides clear, step-by-step instructions to help users complete the form accurately and confidently.

Follow these steps to complete the OH JFS 01960 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's name in the designated field. This should be the full name of the individual who requires ambulance service.
3. Input the patient's address accurately, ensuring to include street, city, state, and ZIP code.
4. Provide the patient's Medicaid billing number as it appears on their Ohio Medicaid card, ensuring accuracy for correct processing.
5. Enter the name of the ambulance provider offering the service. This identifies who will be responsible for the transportation.
6. Fill in the seven-digit Medicaid provider number of the ambulance provider for identification with Medicaid services.
7. Indicate the date(s) of the first transport. This can be a single date or a range of dates, depending on the transport necessity.
8. Select the appropriate reason(s) why the patient must use an ambulance instead of other types of transport by checking the applicable box.
9. Describe the specific medical condition that necessitates the use of an ambulance, using clear language that can be understood by a layperson. This should back up the selections made in step 8.
10. Specify how long the patient may require ambulance transport by selecting whether it is temporary or permanent and providing the relevant duration if temporary.
11. Complete the optional comments section if additional information needs to be provided regarding the patient's transport requirements.
12. Print the name of the attending practitioner who ordered the ambulance transport and include their Medicaid provider number, ensuring not to use 9111115.
13. Gather the necessary signatures in the designated areas from the attending practitioner or appropriately authorized personnel and include the date of signature.
14. Review all entries for accuracy. Once satisfied, you may save changes, download, print, or share the completed form as needed.

Complete the OH JFS 01960 form online today to ensure timely and accurate processing of your medical transport needs.