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PENNSYLVANIA DEPARTMENT OF HEALTH EMERGENCY MEDICAL SERVICES OFFICE Vehicle # ALS Mobile Care and BLS Inspection Checklist I. GENERAL INFORMATION: Name of Ambulance Agency: Address: (Primary Headquarters)
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How to fill out name of ambulance agency:

01
Start by writing the full and official name of your ambulance agency, ensuring it is accurately spelled and formatted.
02
Include any additional identifiers or acronyms that are commonly associated with your agency.
03
If applicable, mention the location or region served by your ambulance agency.
04
Include any certifications or accreditations that your agency holds, such as being a designated trauma center or a certified mobile intensive care unit.
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Provide contact information for your agency, including a phone number or website, so that individuals can easily reach out if needed.

Who needs the name of ambulance agency:

01
Emergency services personnel - When responding to emergencies, it is crucial for other emergency services providers, such as police or fire departments, to know the name of the ambulance agency involved for effective coordination.
02
Patients and their families - By knowing the name of the ambulance agency that transported them or their loved one, patients and their families can facilitate communication, follow-up, or inquiries regarding the medical transport.
03
Medical facilities - Hospitals, clinics, and other healthcare facilities require accurate information about the ambulance agency involved in patient transfers, ensuring proper documentation and coordination of care.
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Insurance companies - For billing and reimbursement purposes, insurance companies often need to be provided with the name of the ambulance agency that provided the medical transport.
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The name of the ambulance agency is typically the legal name of the organization providing ambulance services.
The ambulance agency itself or its authorized representative is required to file the name of the ambulance agency.
The name of the ambulance agency can usually be filled out on a form provided by the relevant regulatory agency or through an online portal.
The purpose of providing the name of the ambulance agency is to ensure proper identification of the organization providing ambulance services.
The information typically includes the legal name of the ambulance agency, any DBA (doing business as) names, and possibly contact information.
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