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 AboutIntegrity Medical Transportation 2018-2023

AboutIntegrity Medical Transportation 2018-2023

Use a AboutIntegrity Medical Transportation 2018 template to make your document workflow more streamlined.

Name 2. GCHP ID Number 3. Member s Preferred Contact Number 4. GCHP Member DOB 5. Servicing Provider/Facility 6. Ventura Transit Service VTS requires at least 48 hours prior notice for all standard requests. Please submit this form in a timely manner to allow for verification of the information provided below 1. Diagnosis 11. Medical purpose/justification for visit s 12. Patient mobilizes via o Wheelchair 13. Mode of transportation requested o Walker o Ambulance o Cane o Bed Bound o Other...
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