LeRoy Emergency Ambulance Service Inc.

A proud partner in our community´╗┐...

Transfer Checklist:

Every Transfer Must have the following:

- PCS (Physicians Certification Form

- Face Sheet

- Pt History, Medication, and Allergies

The Following May be required when applicable:

- SASS/ Crisis Notes


- A copy of the Involuntary Admit Form

Medicaid Only

- As of Feb 1, 2019 you only need to fax the PCS to 

Less than three days notice: 630-873-1441

More than three days notice: 630-873-1450

New PCS is here!!!

Must be used starting

Feb 1, 2019. 

Transfer Information:
To Schedule a transfer call (309) 962-6114