Forms

Information

Phone(410) 548-5142

Fax: (410) 219-2885

Office Hours: Monday - Friday - 8:00 AM - 5:00 PM

Main Office801 North Salisbury Blvd., Salisbury, MD 28101

Resources:

Bus Tickets:

Medical Transportation can distribute bus tickets to eligible clients ONLY if they have three or more appointments per week. All appointments must be documented by the provider and received by our office prior to issuing bus tickets.See links above for the form.


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.



Medical Assistance Transportation Program

The Wicomico County Health Department oversees the Maryland Medical Assistance Transportation Program to provide complimentary, non-emergency transportation to qualified Medical Assistance Recipients. Medical Assistance Transportation is for Wicomico County residents with active Medicaid who have no other means of  transportation available to get to their medical appointments. This is a shared ride program – if you qualify for the service,…

Go to Medical Assistance Transportation Program →


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