Ambulance Billing Forms

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Last Updated on Thursday, 02 October 2014 15:25

Pullman Fire Department
Ambulance Billing Forms

icon General Transport Information Form (right-click Save As)
If you had medical insurance coverage at the time of your ambulance transport, please print this form to complete it and return it to the City of Pullman Ambulance Department. 

icon Motor Vehicle Accident Insurance Form (right-click Save As)
If your ambulance transport was related to an automobile accident, please print this form to complete it and return it to the City of Pullman Ambulance Department. 

icon Employment Accident Insurance Information Form (right-click Save As)
If you have an employment related injury, please print this form to complete it and return it to the City of Pullman Ambulance Department.

icon Medical Records Release Form (right-click Save As)
This form gives your authorization for the release of protected health information, please print this form to complete it and return it to the City of Pullman Ambulance Department. 

 

If you have any questions regarding the billing process, please don’t hesitate to contact the City of Pullman Ambulance Department at (509) 332-8172.


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