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Get and Sign Pcs Form 2010-2022
(answer 1 through 5)
Yes
No
1. Can the patient be safely transported by car, taxi, bus or a wheelchair van, seated
for the duration of the transport, and without a medical attendant?
If yes, the patient does not meet the criteria for stretcher transportation.
Yes
No
2. Is the beneficiary able to get up from bed without assistance?
Yes
No
3. Is the beneficiary able to ambulate?
Yes
No
4. Is the beneficiary able to sit in a chair or wheelchair?
5. Please describe the medical reason(s) why the...
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