Section He-W 572.07 - Documentation(a) Each ambulance provider shall maintain supporting records in accordance with He-W 520.(b) Each ambulance provider shall maintain documentation in their records to fully support each claim billed for services, including: (1) For emergency transportation, documentation of the nature of the recipient's emergency medical condition; and(2) For all ambulance transportation, documentation that justifies the level of service, whether ALS or BLS, claimed.(c) For each trip billed in (b) above, the ambulance provider shall maintain a run sheet or patient care report that includes at a minimum the following information, which is legibly written: (1) Recipient name and medicaid identification number;(3) Origin and destination;(4) Recipient vital signs;(5) Recipient signs and symptoms upon arrival at the point of pick-up;(6) Recipient status en-route;(8) The name of the person who provided the service or care in the ambulance, including signature and credentials; and(9) The response code that indicates the mode of response for the ambulance making the trip.N.H. Admin. Code § He-W 572.07
(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
New. #8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13 (from He-W 572.06 )