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Medical Assistance Transportation Program (MAP) Application Part A TO BE COMPLETED BY CUSTOMER SS# NAME ADDRESS CITY/ZIP PHONE DATE OF BIRTH / / IN CASE OF EMERGENCY CONTACT: EMERGENCY ADDRESS PHONE

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What is medical assistance transportation program?

Medical Assistance Transportation Program provides transportation services to eligible Medical Assistance beneficiaries who need transportation to and from medical appointments.

Who is required to file medical assistance transportation program?

Healthcare providers or transportation companies that provide transportation services to Medical Assistance beneficiaries are required to file the program.

How to fill out medical assistance transportation program?

The program must be filled out with accurate information about the beneficiary needing transportation, the type of transportation required, and the dates and times of medical appointments.

What is the purpose of medical assistance transportation program?

The purpose of the program is to ensure that eligible Medical Assistance beneficiaries have access to transportation services to attend medical appointments and receive necessary healthcare.

What information must be reported on medical assistance transportation program?

The program must include details such as the beneficiary's name, Medical Assistance identification number, appointment details, provider information, and the type of transportation needed.

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