Get Medical Certification Form 272mn Revised 2-21-14.doc

This guide provides clear and supportive instructions on how to complete the Medical Certification Form 272MN Revised 2-21-14.doc online. Our goal is to ensure a smooth and efficient process for users, whether they have prior experience with medical documentation or not.

Follow the steps to accurately complete your medical certification form.

1. Press the ‘Get Form’ button to access the Medical Certification Form 272MN Revised 2-21-14.doc and open it in your chosen editor.
2. In the ‘Recipient Information’ section, enter the full name of the recipient, their Medicaid ID number, and date of birth. Ensure all entries are complete and legible.
3. Navigate to the ‘Verification of Necessity’ section. Fill in the start and end dates of service, ensuring they do not exceed a three-month period.
4. For the ‘Reason for the Transport’ field, select the appropriate options indicating the purpose of the ambulance transport, such as medical appointments or treatments. If 'Other' is selected, provide a brief description.
5. If applicable, check the box indicating if the recipient is ‘bed confined’. Ensure all criteria for this designation are met before marking this option.
6. Check the box if other means of transport are contraindicated or would potentially harm the recipient. Be prepared to describe the medical necessity in the designated area.
7. In the following section, review and check any conditions that existed at the time of transport that support the medical necessity for ambulance services.
8. Complete the ‘Medical Certification’ section by having the healthcare provider certify the information's accuracy and sign. The signature must be provided by a qualified healthcare professional.
9. Finally, review the completed form for accuracy. Save the changes made to the document, and prepare to download, print, or share the form as needed.

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