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Sample Signature Forms
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Please Note: User agrees to all Terms of Use defined below by clicking any of these links. Do not download these forms if you do not agree to these terms.
Terms of Use: the forms being made available for download on this site are sample forms only, designed to assist ambulance services in complying with applicable Medicare signature requirements. These forms and their accompanying instructions are not legal advice, and no attorney-client relationship is formed by their use. These are not official forms of any governmental agency and may not reflect requirements of state law where you live. Any individual or entity using any of these forms (“user”) or any modified version of any of these forms does so with the understanding that the user bears all responsibility for compliance with all applicable laws and regulations, and the user agrees that the designers of these forms are not responsible for their use by any user. Do not use any of these forms or any modifications of them if you do not agree to the terms and conditions of this license. These forms may be modified by the user to meet the user’s needs, though we bear no responsibility for any modifications. These forms are licensed only for use by individual ambulance services; and should not be forwarded to any other organization. Any other use or distribution requires our express written permission. Please also note that we expect to periodically update these forms for various reasons, and we cannot be responsible to distribute new or updated forms to users.
Sample Ambulance Signature Form
2009 Signature Form (Word Format, Customizable)
2009 Signature Form (PDF Format)
Signature Form Instructions (PDF Format)
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Final Signature Rule Webinar Recording
$208.95
This critical webinar focused on the signature requirements that directly affect your ambulance service's bottom line and proper billing for your services. The PWW attorneys “cut through the confusion” on these changes and show you exactly what you need to know. Recorded on 12/5/08.
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