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Get Intelliride Standing Order Request Form 2019-2025
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How to fill out the Intelliride Standing Order Request Form online
Filling out the Intelliride Standing Order Request Form online is a straightforward process designed to gather essential information for transportation services. This guide will provide you with step-by-step instructions to ensure your form is completed accurately and efficiently.
Follow the steps to complete the form effectively.
- Click the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
- Begin by filling out the member information section. Enter the user's first name, last name, phone number, date of birth, Health First Colorado ID number, and email address. Ensure all information is current and spelled correctly.
- In the reason for standing order section, select at least one purpose for the standing order, such as dialysis, chemotherapy, mental health services, radiation, speech therapy, physical therapy, or any other relevant reason.
- Complete the user's street address, city, state, and zip code in the pickup information section. Add any relevant pickup notes, such as gate codes or specific instructions for the driver.
- Indicate whether the user will be accompanied by an escort or personal care attendant and provide a contact phone number for the escort.
- Fill out the facility name and address where the user will be picked up.
- In the dropoff information section, enter the medical provider's name and indicate whether the user has access to a working vehicle by choosing ‘Yes’ or ‘No’.
- Provide the appointment start time, end time, start date, and end date (if applicable). Specify the days of the week on which the appointments will occur.
- Read the agreement section carefully. Acknowledge that providing false information may lead to prosecution and confirm the accuracy of the provided information under penalty of perjury.
- Complete the agreement by signing and printing your name, indicating your relation to the member. Ensure that the signature is clear and legible.
- For IntelliRide use, the form will be reviewed for reservation status. The staff will complete the necessary sections, including staff initials.
- Finally, save your changes to the form. You may also download, print, or share the completed form as needed.
Complete your Intelliride Standing Order Request Form online today for seamless transportation services.
You can obtain a standing order form from various sources, including your healthcare provider's office, medical clinics, and online platforms like uslegalforms. These avenues provide easy access to the Intelliride Standing Order Request Form, making it convenient for you to arrange necessary medical transportation.
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