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HIP Medical Necessity Taxi Transportation Request Form.pdf
Please complete this form and fax it to 1-631-719-0911 to obtain prior approval of medically necessary taxi transportation for Family Health.
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doh-2015.pdf
Can the enrollee utilize mass/public transportation? Yes. No. If Yes, please proceed to the Medical Provider Information section of this Form.
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Non-Emergency Medical Transportation (NEMT)
Dec 3, 2020 The form will not be processed for the requested authorizations if it is missing medical necessity information or justification. Please.
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