Transfer Forms
The following forms should be used and provided for inter-facility transfers:
- EMTALA Transfer Form from the facility
- PCS ( Please make sure the physician or designee as printed the name who has signed it)
- Patient face sheet
- Patient Insurance Cards
- Copy of driver's license, optional
- No orders sheet is needed
Physician Certification Statement | |
File Size: | 108 kb |
File Type: |
Billing Questions:
LifeQuest www.lifequest-services.com N2930 STATE ROAD 22 Wautoma WI 54982-5267 (800) 786-4911 - Toll Free (920) 787-2291 (920) 787-4033 - Fax |
City of Reedsburg Ambulance
230 Railroad Street Reedsburg, WI 53959 608-524-3074 Fax: 608-768-0907 Office hours 7am-4pm |