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Medical Necessity Forms & Other Information

MassHealth Forms & Information

Effective July 1, 2016, MassHealth now requires specific MassHealth-issued Medical Necessity Forms (MNF’s) in order to constitute valid authorization for:

  1. non-emergency wheelchair van transportation provided to MassHealth members who reside in institutional settings;

  2. non-emergency wheelchair van transportation provided to MassHealth members who reside in the community and need mobility assistance from transportation provider personnel to exit their residences or to move from their residences to the vehicle; and

  3. non-emergency ambulance transportation provided to any MassHealth member, regardless of where the member resides.

See the full bulletin issued by the Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid by clicking here for a PDF download.

Don’t Worry! Alert Ambulance is here to make the process as easy as 1-2-3!

We pre-filled these downloadable forms out with our information to save you time!

  1. Find out if the patient needs an Ambulance (stretcher/cot) or a Chair Car (wheelchair) for transportation

  2.  Click on the MassHealth PDF form you need below

  3. Print out as many as you need and fill out the information required before our amazing staff arrives to transport your amazing patient

Wheelchair MNF

Ambulance MNF

Other Medical Necessity Forms & Information

For all of your other patients (without MassHealth) who need a Medical Necessity Form you should use the one we have made for you below.  Just click on the photo and a downloadable PDF will appear!

General Ambulance MNF

EMS Activation & Transport Guide

We at Alert Ambulance strongly believe that no matter what, Patient Care Comes First.  We also understand that sometimes it can be difficult to make the decision of whether you should dial 911 or Alert Ambulance when a patient is in need.  Our experienced medical staff in conjunction with state and local laws has created a guide for your staff to use when that situation arises.  Feel free to print the following guidelines out and keep at each of the nurses stations.

Simply click each photo below for a link to the downloadable PDF of each or click here to download both guides combined into one PDF document.

Patient Transport Guide

EMS Activation Guide

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