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Long Distance Emergency Transportation
Approval Request Form
Fax To:
Transportation Department
FAX#: (716) 5646250
TEL#: 1888FIDELIS (18883433547)
Member Name(Last, DOB:First, M.I.):Fidel is I. D:
Medicaid
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How to fill out long distance non-emergency transportation
How to fill out long distance non-emergency transportation
01
Start by gathering all the necessary information about the patient and their medical condition.
02
Contact the transportation provider and provide them with the details of the patient's medical condition, required equipment, and any special accommodations.
03
Schedule the transportation well in advance to ensure availability.
04
Make sure to have the patient's medical records and prescriptions on hand during the transportation.
05
Prepare any necessary travel documents or authorizations, especially for crossing state or country borders.
06
Ensure that the patient is comfortable during the journey, by providing necessary supplies like pillows and blankets.
07
Monitor the patient's condition throughout the journey and communicate any changes to the transportation provider.
08
Once the journey is complete, follow up with the patient's healthcare provider if necessary.
09
Keep all receipts and documentation related to the transportation for insurance or reimbursement purposes.
Who needs long distance non-emergency transportation?
01
Long distance non-emergency transportation is needed by individuals who cannot travel by regular means due to their medical condition.
02
This can include individuals with chronic illnesses, disabilities, or individuals who require specialized medical equipment during transport.
03
It is also used for transporting patients between medical facilities for specialized treatments or consultations.
04
In some cases, family members may also use this type of transportation to accompany a patient who needs assistance or support during the journey.
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What is long distance non-emergency transportation?
Long distance non-emergency transportation refers to the transportation of individuals who are not in need of immediate medical attention over a long distance.
Who is required to file long distance non-emergency transportation?
Providers of long distance non-emergency transportation services are required to file the necessary paperwork.
How to fill out long distance non-emergency transportation?
To fill out long distance non-emergency transportation paperwork, providers must include information about the individual being transported, the distance of the trip, and any special accommodations needed.
What is the purpose of long distance non-emergency transportation?
The purpose of long distance non-emergency transportation is to ensure that individuals who require non-emergency medical care can safely and comfortably reach their destination.
What information must be reported on long distance non-emergency transportation?
Information such as the name of the individual being transported, the date and time of the trip, the origin and destination of the trip, and any relevant medical information must be reported on long distance non-emergency transportation forms.
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