LifeFlight

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Referral Info

We know how important the first hour after a health tragedy can be. That's why we're making it easier for you to access the information you need when you call LifeFlight.

Physician Certification Statement (PCS) for Ambulance Transport

This form must be signed by the REFERRING Physician, Physician Assistant or Nurse Practitioner. It certifies that the referring practitioner feels the patient has an appropriate medical condition for ground transport (to transport the patient to and/or from the airport for air ambulance transport). This form is required in addition to the Medical Necessity Form. Ideally, it should be completed and faxed back to the LifeFlight office at (701) 234-7054 or presented to the transport crew prior to departing the referring facility.

• PCS for Ambulance Transport

Dispatch Information Required for LifeFlight.

Information you can expect to be asked for, and should have available when calling for LifeFlight.

Helicopter Service Guidelines for Pre-Hospital Personnel (aka LZ Sheet)

Directions for setting up a helicopter landing zone and tips for working safely near helicopters.

• Helicopter Service Guidelines

Medical Necessity Form

This form MUST be signed by the REFERRING Physician, Physician Assistant, or Nurse Practitioner. It certifies that the referring practitioner feels the patient has an appropriate medical condition for air-ambulance transport. Ideally, it should be completed and faxed back to the LifeFlight office at (701) 234-7054 or presented to the transport crew prior to departing the referring facility.

• Medical Necessity Form

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