The Physician Certification Statement (PCS) of Medical Necessity for Non-Emergency Ambulance Transportation is available for download for your use when requesting non-emergency ambulance transportation.  Click on the button to the right to view and print the appropriate PCS form.   The form is designed to be two-sided.  Please be sure to duplex print or photocopy page one on the front and page two on the back of your paper.
Agency	Link
Central Oregon Coast Fire & Rescue District
City of Ashland Fire & Rescue
City of Elgin Ambulance Service
City of La Grande Fire Department
City of Newberg Fire Department
City of Oakridge Fire Department
City of Union Emergency Services
Crooked River Ranch Fire District
Hermiston Fire & Emergency Services
North Douglas County Fire & EMS
Polk County Fire District No. 1
Springfield Fire & Life Safety or Lane Rural Fire/Rescue
St. Paul Fire District

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