All forms can be faxed to (781) 643-0409
Notice of Privacy Practices
PURPOSE: Provides a description of how your medical information collected by Armstrong Ambulance Service may be used and disclosed and how you can access this information
FOR USE BY: Armstrong Patients or Patients’ Authorized Representative
Patient Signature Form
PURPOSE: Authorization to bill for services
FOR USE BY: Armstrong Patients or Patients’ Authorized Representative
Physical Certification Statement (PCS)
PURPOSE: Medical necessity for ambulance transport
FOR USE BY: Physicians and other appropriate clinical personnel