Requesting Information

• Name of requesting person and call-back number

• Referring agency for where the patient needs to be picked up

• Receiving agency for where the patient will be transported

• Anticipated time of pick-up

• Patient’s name and demographics

• Patient’s diagnosis

• Any special needs or equipment for the patient’s care during transport

• Form of payment

• Whether or not the patient will be flying alone (all additional passengers must be approved prior to transport)