Skilled Nursing Facility Payment Agreement


Topic of Agreement

Amerikare LLC and Skilled Nursing Facility:

are in agreement to the following with regards to:

To provide payment for services rendered by providing medical transportation on the behalf of the patient ie: ambulance an/or stretcher.

Type of Transport:

Patient Information:

(*Please note if this transport is a wait and return additional charges may apply* the first 30 minutes are included in the facility rate)

****Over this will be charged $50.00 per 15 minutes increments****