Medical Transportation Forms

Ambulance

State to State Ambulance Transportation Addedum (DMA372-118A)

Note: The following form is found on the NCTracks Prior Approval web page

• The State-to-State Ambulance Transportation Addendum (372-118A)

Non-Emergency Medical Transportation (NEMT)

• Non-Emergency Medical Transportation Manual Section (MA-2910)
• Medicaid Transportation Reimbursement Request Form (DMA-2055)