Commonly needed forms are provided below as downloadable PDF files.
HIPAA Notice
The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The Rule also gives patient’s rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections.
What is a Physician Certification Statement? The Physician Certification Statement (PCS) is the written order certifying the medical necessity of non-emergency ambulance transports. The regulations governing PCS requirements are specified in the Code of Federal Regulations at 42 CFR 410.40(d
Physician Certification Statement Requirements
A PCS is required
for the following ambulance services:
Nonemergency, scheduled, repetitive ambulance services, and
Unscheduled, nonemergency ambulance services or nonemergency ambulance services scheduled on a nonrepetitive basis for a resident of a facility who is under the care of a physician
Note: For nonemergency, scheduled, repetitive ambulance services, the physician’s order must be dated no earlier than 60 days before the date that the service is furnished.
