Part B: Health Care Provider Certification 2026

1. Click ‘Get Form’ to open the Part B: Health Care Provider Certification in the editor.
2. Begin by entering your details in the 'Health Care Provider' section. This includes your name, institution, license number, specialization, and contact information.
3. Provide a written diagnosis along with the relevant ICD-9CM and/or DSM codes in the designated field.
4. Indicate how long you have been treating the patient and when you last saw them. This information is crucial for assessing their current condition.
5. Select whether the applicant’s disability prevents them from using accessible MTS services. If yes, elaborate on how their condition impacts their travel abilities.
6. Check any mobility aids or devices that the applicant requires and provide additional details if necessary.
7. Answer questions regarding medication side effects and other factors affecting the applicant's ability to use transit services. Be thorough in your explanations.
8. Finally, review all entries for accuracy before signing and dating the certification at the end of the form.

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