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The Physician Certification Statement (PCS) is the written order docHubing the medical necessity of non-emergency ambulance transports. The regulations governing PCS requirements are specified in the Code of Federal Regulations at 42 CFR 410.40(d).
The PCS must be dated no earlier than 60 days in advance of the transport for those patients who require repetitive ambulance services and whose transportation is scheduled in advance. The PCS may include the expected length of time ambulance transport would be required but may not exceed 60 days.
All PCS forms for all patients require a physicians signature. The only acceptable alternatives to a physicians signature are signatures of a Physicians Assistant, Registered Nurse Practitioner, Registered Nurse, and Certified Nursing Specialist a Discharge Planner or a resident at a teaching hospital.
Ambulance providers are required to obtain a Physician Certification Statement (PCS) from the patients attending physician for non-emergency ambulance trips from a facility under the direct care of a physician (CAH, SNF, etc.)
Ambulance providers are required to obtain a Physician Certification Statement (PCS) from the patients attending physician for non-emergency ambulance trips from a facility under the direct care of a physician (CAH, SNF, etc.)

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Physician certification statements (PCS) are required for patients who are under the direct care of a physician and are required for: Scheduled non-emergency ambulance transports.
All PCS forms for all patients require a physicians signature. The only acceptable alternatives to a physicians signature are signatures of a Physicians Assistant, Registered Nurse Practitioner, Registered Nurse, and Certified Nursing Specialist a Discharge Planner or a resident at a teaching hospital.

certification of ambulance transportation form