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