LeRoy Emergency Ambulance Service Inc.
A proud partner in our community...
To Schedule a transfer call (309) 962-6114
Every Transfer Must have the following:
- PCS (Physicians Certification Form
- Face Sheet
- Pt History, Medication, and Allergies
May be required when applicable:
- SASS/ Crisis Notes
- A copy of the Involuntary Admit Form
(Medical Certificate for Non-Emergency Transport: Only needed if being discharged from the hospital)
(Please make sure to print the form and confirmation)
MCA Printing Instructions
How are we doing?
Meridian Prior Authorization