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MC MCD INS Signature Form-NCAS - Nevada County Ambulance ...

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The document is a Patient Signature Form for the Nevada County Ambulance Service, which authorizes payment from Medicare, Medicaid, or private insurance for services rendered. It outlines the patient's financial responsibility, the assignment of payment rights to NCAS, and the authorization for NCAS to appeal payment denials. The form also includes sections for patient signatures, representatives if the patient is incapable of signing, and ambulance crew and hospital representative signatures.

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