Facility Transport Forms
(For Use by Health Care Facilities Only)
The following forms must be completed
before transport will be scheduled:
- Please download the Sunstar Interfacility Patient Billing Forms linked below.
- Complete a set of forms for each patient who is to be transported.
- Fax forms to 727-582-2540 before calling the communication center.
Questions? Our non-emergency phone number is 727-587-2111.1. PCS billing form (235K)
Please complete before scheduling a transport.
2. Billing (Date: 04/09/2009) (115K)
Sunstar Interfacility Billing Form
HIPAA Notice of Privacy Practices
To download our Notice of Privacy Practices please click here.
Special Note
Medicaid has established criteria for ambulance transports that our office must adhere to in order to file a claim. Eligibility for Medicaid does not guarantee that Medicaid will pay for a patient’s ambulance services. Questions regarding Medicaid’s criteria should be referred to the patient’s local Medicaid Office. Transports resulting from a motor vehicle accident will require the patient to complete an automobile insurance information form that will be mailed by Sunstar Paramedics. It is important to complete this form in its entirety. Once the form is returned to Sunstar, our billing team will file a claim directly with the customer’s insurance carrier. The customer’s account will then be placed on hold to allow ample time for the insurance company process the claim. The remaining balance will be billed to the customer.