Patient
Patient Transport Request
Schedule a non-emergency medical transport. Includes pickup details, destination, and medical needs.
Coming soon
Forms & Applications
Everything you need, in one place.
Download the forms you need for transport requests, insurance, HIPAA authorization, and employment applications.
Need help completing a form?
Our team is happy to walk you through any application. Call (670) 234-2273 or email admin@saipanprioritycare.com.
Patient Forms
For scheduling transports and medical documentation.
Patient
Physician Certification Statement (PCS)
Required for Medicare-covered non-emergency ambulance transports. Signed by the ordering physician.
Coming soon
Compliance
HIPAA Authorization & Release
Authorize Priority Care Services to share protected health information with your care providers.
Coming soon
Compliance
Advance Beneficiary Notice (ABN)
Medicare notice for services that may not be covered.
Coming soon
Insurance & Billing
Insurance authorization and financial forms.
Insurance
Insurance Authorization
Provide insurance details and authorize billing for transport services.
Coming soon
Insurance
Assignment of Benefits
Assign insurance benefits directly to Priority Care Services for covered transports.
Coming soon
Insurance
Financial Hardship Application
Apply for reduced-cost transport based on demonstrated financial need.
Coming soon
Employment Applications
Join our team serving Saipan since 2013.
Employment
Employment Application — EMT
Apply to join our team of certified EMT professionals on Saipan.
Coming soon
Employment
Employment Application — Driver
Apply for ambulance driver positions. CDL and clean driving record required.
Coming soon
Employment
Employment Application — Administrative
Apply for dispatch, billing, and office support positions.
Coming soon
Can't find the form you need?
We can send additional forms by email or fax on request. Our office is open Monday through Saturday, 5:00 AM to 10:00 PM.