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Filling out the Repetitive Patient Physician Certification Statement (PCS) is a crucial step in ensuring the medical necessity for non-emergency transports is documented accurately. This guide provides clear, step-by-step instructions to help you complete the form online with confidence.

Follow the steps to fill out the form accurately.

1. Press the 'Get Form' button to access the form and open it in your preferred form editor.
2. In the first section, enter the patient’s name, date of birth, Medicare/Medicaid ID, the location they were transported from, and the dates of service. Indicate whether the transport was a round trip by selecting 'Yes' or 'No'.
3. Next, provide the destination for the transport and the printed name and NPI of the ordering physician.
4. Document the patient's medical condition at the time of transport to justify the ambulance's medical necessity. Ensure to answer all three criteria regarding bed confinement with 'Yes' or 'No'. If you respond 'Yes' to all, complete sections 3-A and 3-B.
5. In Section 2, explain any reasons the patient cannot maintain an upright position or cannot sit in a chair due to medical conditions. Specify any decubitus ulcers indicating their location on the body.
6. List any medical history or diagnoses that substantiate the need for ambulance transportation.
7. For repetitive patients, ensure the authorizing physician completes and signs the certification in Section 3. This validates the information and must be signed within 60 days of the transport.
8. After completing the form, you can save your changes, download a copy, print it, or share the completed PCS as needed.

Get started with filling out your PCS form online today.