108 E. Main Street
Salisbury, MD 21801
(410) 749-1244


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FORMS


PLEASE NOTE: Beginning July 1, 2018 please utilize the new forms below. There will now be only one certifcation form for all mobility - ambulatory, wheelchair, and stretcher. For transfers or discharges from a facility, please use the seperate Transfer & Discharge form. 

Below are the forms required for Medicaid Transportation. The Provider Certification Form (PCF) is required for every client, and the Distant Transport Form is required for every out of area referral. Frequency of forms may vary, contact our office for more information.



The bus ticket appointment verification form is to be completed by  a medical provider, and used for clients who have three or more medical appointments per week. See form for further instructions.




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