Follow the steps to complete the form efficiently.

1. Click 'Get Form' button to obtain the PGMA Medical Assistance Transport Certification Form and open it for editing.
2. In Section 1, input the patient's personal information. Provide their last name, first name, home address, city/state/zip code, date of birth, phone number, and other relevant identification numbers such as social security, medical assistance number, and medicare number.
3. Moving to Section 2, list the underlying medical diagnosis and describe the medical condition that necessitates transportation. Include current symptoms and the patient's weight and height.
4. In Section 3, certify the patient's need for medical transportation by affirming whether the condition prevents the use of public transportation and whether an escort is required during the transport.
5. Choose one certified mode of transportation in Section 4. Indicate whether the patient is ambulatory, requires a wheelchair, or needs an ambulance. Include necessary details based on the selected option.
6. In Section 5, assess whether the patient can be transported by sedan or wheelchair van, if they are bed confined, and the justifications for requiring ambulance service.
7. Finally, Section 6 must be completed by a certified provider. Ensure they sign and provide their medical assistance number and contact details before submitting the form.
8. After completing the form, save changes, and choose to download, print, or share the form as necessary.

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