Forms
Notice of Privacy Practices
This notice describes how medical information collected by Armstrong Ambulance Service may be used and disclosed, and how patient's can access this information.
Patient Signature Form
Purpose: Authorization to bill for services
For use by: Armstrong Patients or Patient's Authorized Representative
Fax to: 781-643-0409
Physician Certification Statement (PCS)
Purpose: Medical necessity for ambulance transport
For use by: Physicians
Fax to: 781-643-0409
Authorization to Release Medical Records
Purpose: To authorize release of medical records to outside parties
For use by: Armstrong Patients or Patient's Legal Representative
Fax to: 781-643-0409