Forms

PCS

The Physician Certification Statement (PCS) Form is written authorization from a Physician, Physician’s Assistant, Nurse Practitioner, Clinical Nurse Specialist, Discharge Planner or Registered Nurse signifying that transport by ambulance is medically necessary and the patient’s condition at the time of transport meets medical necessity requirements.

Our Transfer Form is available for you to use to schedule Non-Emergency Ambulance Transports. Once received, a MEDIC EMS Dispatcher will contact you to finalize the transfer.

If this is a time critical patient transport, please contact MED-COM immediately at (563) 323-1000.

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