Forms
First Transit's fax number is (630) 873-1450.
- For transport originating at a hospital or long-term care facility - HFS 2270, Physician Certification Statement (PCS) for Ambulance Transport or Medicar/Service Car Transport. If the form does not open in your browser - right-click on the link, select Save Link As (or Save Target As), save the file to your computer, then open the saved file in Adobe Acrobat.
- For residential transports - CTS Form (please see provider notice dated 4/22/22 for instructions on when to use). This change goes into effect on 6/1/22 (see provider notice dated 4/29/22). If the form does not open in your browser - right-click on the link, select Save Link As (or Save Target As), save the file to your computer, then open the saved file in Adobe Acrobat.
- HFS 2270 Physician Certification Statement and Transportation Provider Complaint Portal
- Transportation PowerPoint Presentation for HFS 2270, Physician Certification Statement
- Standing Prior Approval (SPA) Form
- Single Trip Form
- Psychiatric Services Treatment Plan Form for CAP/GAP Providers
- Psychiatric Services Treatment Plan Form for Provider Type 36 (LPHAs)
- HFS 3701T Therapy Prior Approval Request Form (if you are unable to view this form, right-click to save the file and then open it in Adobe Reader directly)
- Complaint Form
