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ATTACHMENT MODEL CONTRACT BETWEEN COUNTY OF ORANGE IDENTITY FOR SENIOR EMERGENCY MEDICAL TRANSPORTATION SERVICES (Funded by FTA Section 5317 New Freedom Grant Funds)1 of 111ATTACHMENT MODEL CONTRACT

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How to fill out nemt service agreement non-ambulance

01

Obtain a copy of the NEMT service agreement non-ambulance form.

02

Fill in all required information accurately, including the client's name, address, contact information, and any pertinent medical details.

03

Read through the terms and conditions carefully to ensure understanding of the agreement.

04

Sign and date the agreement where indicated.

05

Make a copy of the completed agreement for your records.

Who needs nemt service agreement non-ambulance?

01

Individuals who require non-emergency medical transportation services but do not need ambulance transport.

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What is nemt service agreement non-ambulance?

Non-emergency medical transportation service agreement for non-ambulance refers to the contract between a transportation provider and a healthcare facility or insurance company to provide transportation services for individuals who do not require ambulance transportation.

Who is required to file nemt service agreement non-ambulance?

Transportation providers offering non-emergency medical transportation services are required to file the service agreement for non-ambulance.

How to fill out nemt service agreement non-ambulance?

The nemt service agreement for non-ambulance must be filled out with details of the transportation provider, services provided, rates, and any other relevant information. It should be signed by both parties involved.

What is the purpose of nemt service agreement non-ambulance?

The purpose of the nemt service agreement for non-ambulance is to establish the terms and conditions of transportation services provided by the transportation provider to the healthcare facility or insurance company.

What information must be reported on nemt service agreement non-ambulance?

The nemt service agreement for non-ambulance must include details such as the name and contact information of the transportation provider, services offered, rates, payment terms, and any additional terms and conditions.

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