Non-Emergency Ambulance Transportation
Non-Emergency Ambulance Transportation
You can use the printable clinical templates and suggested clinical data elements (CDEs) for the order / physician certification statement, progress note, and prior authorization request to assist with documenting your medical records to support the need for Non-Emergency Ambulance Transportation (NEAT).
Health IT Vendors: To use the suggested CDEs, download or print and use as guidance in creating or enhancing existing electronic clinical templates within your electronic health record (EHR) system.
Providers: To use a printable clinical template, download and/or print the template, complete as applicable and file in the patient’s medical record.
| Type of Documentation | Download |
|---|---|
| Order / Physician Certification Statement (PCS) | |
| Non-Emergency Ambulance Transportation Order-PCS | CDEs (PDF) Draft R1.0e 7/20/2018 |
| Template (PDF) Draft R1.0e 7/20/2018 | |
| Progress Note | |
| Non-Emergency Ambulance Transportation Progress Note | CDEs (PDF) Draft R1.0e 7/20/2018 |
| Template (PDF) Draft R1.0e 7/20/2018 | |
| Prior Authorization (PA) Request | |
| Non-Emergency Ambulance Transportation PA Request | CDEs (PDF) Draft R1.0e 7/20/2018 |
| Template (PDF) Draft R1.0e 7/20/2018 |
We want to hear from you! Email us your comments and suggestions about the draft templates and CDEs.
Page Last Modified:
12/01/2021 05:40 PM