Facility Transport Information

(For Use by Healthcare Facilities Only)

To Schedule an Ambulance Transport

  • Please download the Noga Ambulance PCS form below
  • Complete this form in its entirety and fax forms to (724) 652-4848 before calling the dispatch center to schedule your transport
  • Attach the hard copy of the completed PCS to the front of the patient’s paperwork for our crews to pick up upon transport

When Our Crews Arrive for Your Transport

  • Please have  paperwork ready along with a quick verbal patient care report
  • This verbal report is required prior to any transfer of care to an EMS agency
  • Report to include…reason patient requires an ambulance for transport, medical history, and any additional relevant information
  • In the event, the patient is unable to sign. Our crew will ask you to sign our computerized Patient Encounter Form
  • This form is required by federal law and does not violate HIPAA, nor does it make you financially liable for payment

Questions? Call our communication center (724) 652-6677


Certificate Medical Necessirty PCS     EMS Transport Medications 400 - 50

Waiver - 400 - 50     EMS Scope of Practice

Patient Encounter Forms - 400-50     ABN - 400-50

OIG     Privacy practices 400-50