Get Senior Medexpress - Yellow Cab Of D.c.

Filling out the Senior MedExpress certification form is an important step for individuals seeking non-emergency transportation for essential medical appointments. This guide provides clear, step-by-step instructions to help you complete the form online.

Follow the steps to complete the Senior MedExpress certification form.

1. Click ‘Get Form’ button to access the certification form and open it in your preferred editing platform.
2. Begin by filling out Section 1, titled 'Patient Information and Authorization of Release of Information.' Provide your full name, date of birth, address including apartment/unit number, phone number, and email address.
3. In Section 1, sign your name, date the form, and ensure that you authorize the release of your medical information. This allows the Department of Aging and Community Living (DACL) to confirm your medical condition with your healthcare provider.
4. Proceed to Section 2, where your healthcare provider will need to complete the 'Healthcare Provider Information.' They should include their name, address, practice phone number, and email.
5. In Section 2, the healthcare provider must also list your diagnosis and describe the medical condition that necessitates your need for transportation to essential medical appointments.
6. Next, Section 3 requires the healthcare provider's signature certifying that you require life-sustaining medical appointments. They should check the appropriate 'Signee Type' box and provide their printed name, phone number, professional license number, and date signed.
7. After all sections are completed, review the entire form for accuracy. Once verified, you can save your changes, print the form, or share it as needed. Ensure all required fields are filled out before submitting.

Complete your documentation online to ensure timely processing of your transportation needs.