Illinois Pcs Form Pdf - Fill Online, Printable, Fillable 2025

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Paramedic Communications Systems (PCS)
Physician Certification Statement (PCS) for Ambulance Transport. IMPORTANT: A patient is only eligible for ambulance transportation if, at the time of transport, he or she is unable to travel safely in a personal vehicle, taxi, or wheelchair van.
Some examples of medical necessity for emergency ambulance transport are: Injury resulting from an accident or illness with acute symptoms like hemorrhage, shock, chest pain, respiratory distress, etc. Oxygen administration due to hypoxemia, syncope, airway obstruction, or chest pain.
Choosing a PCS Completion Mode in AngelTrack If the ePCS is signed by a PA, NP, CNS, RN, or discharge planner, the document will be valid only for the round trip; if signed by a physician, the document will be valid for a date range specified in the form -- up to the 60-day limit imposed by the CFR.
Medicare Certificate of Medical Necessity CMN/PCS Form: The CMN (Certificate of Medical Necessity) is for patients who have Medicare and Medicare Advantage/Replacement Programs. This form is required for all non-emergency transports. The form must have the patients Full Name, DOB and Date of Trip.
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