Interested in joining MAAS? Complete this application and return it to use. You can use the online form.
Non-Emergency Transport Forms
Even with the below forms completed, there is no guarantee that your insurance provider(s) will make payment for emergency or non-emergency medical transportation. Additionally, MAAS may require prepayment for non-emergency transport.
This form is to be completed by the patient prior to the transport, acknowledging that MAAS believed that the charged could potentially be deemed not medically necessary and could be responsibility of the patient and not their insurance provider.
Certification of Medical Necessity
This form is to be completed by your physician as to why you need an ambulance transport in a non-emergent situation. This from may also be completed by a Physician Assistant, Clinical Nurse Specialist, Registered Nurse, Nurse Practitioner, or Discharge Planner. If the for is for repeat transfers, then it must be completed by a Physician.