Instructions

User Manual:

Open the PDF directly: View PDF PDF.
Page Count: 2

DownloadInstructions
Open PDF In BrowserView PDF
Limo Carerides
Non-Emergency Medical Transportation
NEMT-APPLICATION
NEMT will assist Medicaid recipients with non-emergency medical transportation to and from their
medical doctor appointments. If the recipients have no other means of transportation, this service is a
benefit provide by Colorado Medicaid.

The appropriate mode of transportation will be determined by your physician on (pg. 2)
All pages of this application must be completed, signed and dated by your Primary Care
Physician, Physician’s Assistant, Nurse Practitioner, Therapist or a licensed healthcare
professional.

If you are being referred to receive care outside of your County, the form “Medical Certification of
Transportation Services – Beyond 25 Miles – Fillable(PDF)”
is required to be completed by the physician that is referring you to seek medical care
outside of the county. They also need to include the reason why you cannot receive care closer
to your home.

The applicant is required to sign and date the attached Declaration (pg. 4) and return with the
completed medical certification application.
Any missing or incomplete forms will delay the eligibility determination process; or may be
denied.
You can submit the completed Medical Transportation Application by one of the following
options:
Mail: 635 W Corona Ave Suite #213 Pueblo Co, 81007

Fax: (719) 545-0499
Email: Medridetransportation@gmail.com
Mailing Address: MedRide LLC.
635 W Corona Ave Suite #213 Pueblo Co, 81004
Phone: (719) 545-3333 Fax: (719) 545
Source Exif Data: 
File Type                       : PDF
File Type Extension             : pdf
MIME Type                       : application/pdf
PDF Version                     : 1.7
Linearized                      : No
Page Count                      : 2
Language                        : en-US
Tagged PDF                      : Yes
XMP Toolkit                     : 3.1-701
Producer                        : Microsoft® Word for Office 365
Creator                         : Bridge Cares
Creator Tool                    : Microsoft® Word for Office 365
Create Date                     : 2019:05:03 15:29:43+03:00
Modify Date                     : 2019:05:03 15:29:43+03:00
Document ID                     : uuid:8E4F80EC-A9AB-4883-A186-FE73B2DE61A5
Instance ID                     : uuid:8E4F80EC-A9AB-4883-A186-FE73B2DE61A5
Author                          : Bridge Cares
EXIF Metadata provided by EXIF.tools

Navigation menu