For ambulance, Call 9-1-1 or 1-800-872-1111

Information for healthcare providers and healthcare facilities

High quality and responsive ambulance transportation for patients is vitally important to hospitals, skilled nursing facilities, physicians and healthcare systems.

Jackson Community Ambulance’s skilled paramedics can improve patient outcomes and shorten hospital stays. For example, field diagnosis and hospital notification of myocardial infarction (heart attack) speeds activation of reperfusion teams and reduces long-term heart damage. Health systems also need timely transportation services as patients are moved from one level of care to another — across a hospital campus, across town, or even across the state.

Scheduling ambulance transportation - 1-800-872-1111

Call JCA’s 24-hour Call Center at 1-800-872-1111. Calling in advance, if possible, allows us to arrive on time, as promised. For faster service, obtain prior authorization by third party payers before scheduling.

JCA and its affiliate ambulance services are licensed to provide non-emergency ambulance service in the following counties:

  • Calhoun
  • Jackson
  • Lenawee
  • Livingston
  • Monroe
  • Oakland
  • Washtenaw
  • Wayne

They can transport patients back to the local area from out-of-area/out-of-state hospitals in certain circumstances. 

Ambulance Transports and Physician Certification Form (PCS) forms

A PCS Form is needed for every nonemergency ambulance transport.
This is the form that you or another health care provider will complete in order to document medical necessity so that a patient’s nonemergency ambulance transport will be covered by Medicare or other third party insurance. PCS Forms need to be signed and presented to the HVA paramedics when they arrive to transport the patient. The PCS form must be signed by one of the following:

  • Physician -Physician Assistant
  • Nurse Practitioner
  • Registered Nurse
  • Certified Nurse Specialist
  • Discharge Planner
  • an LPN who is also a Discharge Planner

This form needs to accurately reflect the patient’s current condition. It must state that the patient cannot be transported in a sitting position and why.

Ambulance Transports for Repetitive Patients (e.g. Dialysis)

We must have a PCS form completed and signed by a physician prior to the first transport. Reasons for medical necessity need to be stated clearly on the form.

PCS forms for dialysis are generally valid for 60 days as long as the medical necessity stays the same. If the patient’s condition changes, please contact the HVA Call Center at 1-800-872-1111 so that we may send the appropriate transportation and the patient will not receive a bill.

We will send a paramedic supervisor to assess your patient’s needs once their dialysis is scheduled. This will help us to follow coverage guidelines and identify issues. The supervisor will then assess the patient every 60 days while they are under our care.

Links to fillable PCS and Repetitive PCS Forms (fill out online and print):

One-Time Transport Physician Certification Statement
Repetitive Transports Physician Certification Statement