Pt1 form 2026

1. Click ‘Get Form’ to open the PT-1 form in the editor.
2. Begin by filling out Section 1 with the MassHealth member's information, including their last name, first name, date of birth, and member ID. Ensure all details are accurate.
3. In Section 2, provide the treating provider's information. This includes their name, telephone number, address, and MassHealth provider ID/service location.
4. Section 3 requires you to indicate the treating provider's facility. If it is the same as in Section 2, simply check the box provided.
5. Detail the medical treatment type in Section 4 by listing all MassHealth-covered services that will be provided.
6. In Section 5, specify how long and how frequently transportation services will be needed for the member.
7. Section 6 asks if there is a medical reason preventing public transportation use; provide a detailed explanation if applicable.
8. Indicate any special transportation needs in Section 7 and complete Section 8 with the required signature from an authorized provider.

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