Social Security Number
Date of Birth
Pick up Address (Apartment Number if applies) or Facility Name
Where the Patient is going? (Address or Facility Name and Doctor’s Names / Suite Number)
For what reason?
What type of Insurance the Patient has?
*Insurance Carriers and Medicare require the Patient’s Social Security Number and Policy Number(s) for identification and to process the claim.
The type of transportation is based on an industry term: “medically necessary” a series of question can determine whether BLS/SCT or 911 is appropriate. Our dispatcher will ask:
Can the patient walk?
Is the patient in a wheelchair?
Is the patient bed bound?
Can the patient maintain a sitting position for an extended period of time?
Does the patient need assistance to stand or pivot?
If the patient can walk or is in a wheelchair, transportation other than an ambulance should be utilized. If the patient is bed bound, cannot sit for an extended period or needs assistance to transfer, an ambulance is utilized.
*In all emergencies, an ambulance is utilized.
Sure, Premier Ambulance can transport you to your hospital of choice if you are stable enough for the transport, which is determined by the EMT who arrives to evaluate you. The information is then relayed to our medical control and the decision to go to a further hospital is then approved or denied by the medical staff. All private ambulance services use this same protocol. 911 will only transport you to the nearest facility.
Any patient going to an emergency room is considered an emergency. Emergency ambulance services are provided after the sudden onset of a medical condition. Acute signs and/or symptoms of sufficient severity must manifest the emergency medical condition such that the absence of immediate medical attention could reasonably be expected to result in one or more of the following:
Place the patient’s health in serious jeopardy
Cause serious impairment to bodily functions
Cause serious dysfunction of any bodily organ or part
In these cases, Premier would respond immediately, meaning our EMS professionals would begin as quickly as possible taking the steps necessary to respond to the call. Non-emergency transports are often scheduled in advance and may cover a variety of things as long as the patient qualifies for an ambulance including hospital to hospital transfers (to a higher level of care), outpatient treatment, etc.
It is your choice; however, 911 can only go to the closest hospital, whereas Premier can transport you to your hospital of choice as long as you are stable enough for transport. Premier Ambulance EMS personnel are trained to the equivalent and/or exceeding a 911 ambulance provider.
Basic Life Support
Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two Emergency Medical Technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator (AED) and basic drug administration. Examples of BLS transports include:
Basic Life Support emergencies
Transport to dialysis
Advanced Life Support
Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed with at least one paramedic who have over 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. Patients who typically require ALS transport include:
Medical/surgical patients with a continuous IV
Patients on a cardiac monitor
Patients with potential airway compromise
Any patient deemed to have a potential complication during transport when reported by the sending facility
Life threatening medical emergencies (For example: stroke, seizure, or chest pains)
Private ambulances are used for emergency transports, non-emergency transports and critical care transfers. Private ambulances can transfer you to your hospital of choice based upon medical stability for transfer whereas 911 can only take you to the closest hospital.
In addition, some private ambulances, Premier being one, have the capabilities to transfer high risk patients on ventilators & IV drips and manage expanded scope medications that your local 911 ambulance typically cannot.
At Premier, we are open 24 hours a day 365 days per year. If you have a medical emergency, please contact us right away so we can get you to the emergency room without delay. If you are looking to schedule an appointment, Premier can do so at any time, however, we like a one day notice if possible to ensure timely performance.
Medicare states non-emergency ambulance transports are considered medically necessary when the patient’s medical condition is such that the use of any other method of transportation (e.g., taxi, private car, wheelchair coach) would be medically contraindicated (e.g., would endanger the patient’s medical condition).
The lack of an available alternate mode of transportation (e.g., taxi, bus, personal car) or the inability to drive does not satisfy the medically necessary requirements. Non-emergency ambulance transport for convenience or because another means of transportation is not available is not considered medically necessary, and, therefore not covered.
If you meet the medical necessity for an ambulance, Premier can transport you for dialysis.
To comply with applicable laws, requests for medical records must be made in writing. In certain cases documentation and signature authorization are needed.
What information do we collect?
We collect information from you when you respond to a survey, send a greeting or fill out a form. You may be asked to enter the following: name, e-mail address, mailing address, or phone number. You may, however, also visit our site anonymously.
We may also collect non-personal identification information about you whenever you interact with this website. Non-personal identification information may include the browser name, the type of device and technical information about your means of connection to our website, such as the operating system, IP address, and the Internet service providers utilized and other similar information.
We may collect information in the form of website server logs. These logs are files that record activity on the website and gather statistics about users’ activities, such as: (1) how many users have visited the website; (2) how often; (3) how many hits the website and a particular webpage has received; (4) sign-in and sign-off times for the website; (5) type and quality of the user’s Internet connection to the website; (6) identification of the user’s hardware and software accessing the website; (7) the features on the website you used; and, (8) the frequency of use. The entries comprising the logs contain IP addresses, user IDs, and identification of the Internet service provider that provides your connection to the Internet. Generally, we use the Logs to operate and improve the website, to identify the popularity of certain features, to assist with internal marketing and demographic studies, to enable us to assess overall efficiency and activity on the website, and to assess users’ web-browsing activities, preferences, and habits. We also use the logs to monitor traffic on the website and to troubleshoot technical problems.
What do we use your information for?
In addition to what is set forth above, any of the information we collect from you may be used to improve customer service, survey or other site feature or to send periodic emails. The email address you provide may be used to send you information, respond to inquiries, and/or other requests.
How do we protect your information?
We implement a variety of security measures to maintain the safety of your personal information when you enter, submit, or access your personal information.
Do we disclose any information to outside parties?
We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information. This does not include trusted third parties who assist us in operating our website, conducting our business, or servicing you, so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, enforce our site policies, or protect our or others’ rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.
California Online Privacy Protection Act Compliance
Because we value your privacy we have taken the necessary precautions to be in compliance with the California Online Privacy Protection Act. We therefore will not distribute your personal information to outside parties without your consent.
Children’s Online Privacy Protection Act Compliance
We are in compliance with the requirements of COPPA (Children’s Online Privacy Protection Act), we do not collect any information from anyone under 13 years of age. Our website, products and services are all directed to people who are at least 13 years old or older.
California Privacy Rights Under California Civil Code Section 1798.83
California users may request further information about our compliance with this law by e-mailing: email@example.com. Please note that we only are required to respond to one request per user each year, and we are not required to respond to requests made by means other than through this e-mail address.
Terms and Conditions
Please also visit our Terms and Conditions section establishing the use, disclaimers, and limitations of liability governing the use of our website.
260 N Palm St Ste 200
Brea, CA 92821
Premier Ambulance website is maintained as a service to its clients (“User”). By using this site, the User agrees to comply with and be bound by the following terms and conditions of use. Please review these terms and conditions carefully. If you do not agree to these terms and conditions, you should not use this site.
Agreement. This Agreement (the “Agreement”) specifies the Terms and Conditions for access to and use of HTTPS://WWW.PREMIERAMB.COM (the “Site”) and describes the terms and conditions applicable to access of and use of the Site. This Agreement may be modified at any time by Premier Ambulance upon posting of a modified agreement. Any such modifications shall be effective immediately. The User can view the most recent version of these terms at any time at HTTPS://WWW.PREMIERAMB.COM/resources. Each use by the User shall constitute and be deemed unconditional acceptance of the Agreement.
Ownership. All content included on this Site is and shall continue to be the property of Premier Ambulance or its content suppliers and is protected under applicable copyright, patent, trademark, and other proprietary rights laws. Any copying, redistribution, use or publication of any such content or any part of the Site is prohibited, except as expressly permitted in this Agreement. Under no circumstances will the User acquire any ownership rights or other interest in any content by or through the use of this Site.
Intended Audience. This website is intended for adults only. This website does not provide services to children under the age of 18. This website is not intended for any children under the age of 13.
Trademarks/Service Marks. “PREMIER AMBULANCE” is a trademark, service mark or registered trademark/service mark and logo of PREMIER AMBULANCE. Other product and company names mentioned on this Site may be trademarks/service marks of their respective owners.
Site Use. PREMIER AMBULANCE grants a limited, revocable, nonexclusive license to use this Site solely for personal use and not for republication, distribution, assignment, sub-license, sale, preparation of derivative works, or other use. User agrees not to copy materials on the Site, reverse engineer or break into the Site, or use materials, products or services in violation of any law. The use of this Site is at the discretion of PREMIER AMBULANCE and PREMIER AMBULANCE may terminate User’s use of this Site at any time.
Compliance with laws. User agrees to comply with all applicable laws regarding your use of the Site. User further agrees that information provided by User is truthful and accurate to the best of User’s knowledge.
Links to Third Party Sites. The Site may contain links to other websites (“Linked Sites”). The Linked Sites are not under the control of PREMIER AMBULANCE and PREMIER AMBULANCE is not responsible for the contents of any Linked Site, including, without limitation, any link contained in a Linked Site, or any changes or updates to a Linked Site. PREMIER AMBULANCE is not responsible for webcasting or any other form of transmission received from any Linked Site. PREMIER AMBULANCE provides these links only as a convenience, and the inclusion of any link does not imply endorsement by PREMIER AMBULANCE of any site or any association with its operators.
Materials Provided to Premier Ambulance or Posted on this Site. PREMIER AMBULANCE does not claim ownership of the materials User provides to PREMIER AMBULANCE (including feedback and suggestions) or post, upload, input or submit to the PREMIER AMBULANCE (collectively, “Submission(s)”). However, by posting, uploading, inputting, providing or submitting a submission, User is granting PREMIER AMBULANCE, its clients, affiliates and necessary sub licensees’ permission to use the submission in connection with the operation for their businesses including, without limitation, the rights to: copy, distribute, transmit, publicly display, reproduce, edit, translate and reformat the Submission; and to publish User’s name in connection with the Submission.
No compensation will be paid with respect to the use of the Submission, as provided herein. PREMIER AMBULANCE is under no obligation to post or use any submission provided and may remove any Submission at any time in PREMIER AMBULANCE sole discretion.
By posting, uploading, inputting, providing or submitting a Submission, User warrants and represents that User owns or otherwise controls all of the rights to the Submission as described in this section including, without limitation, all the rights necessary to provide, post-upload, input or submit the Submission(s).
Indemnification. User agrees to indemnify, defend and hold PREMIER AMBULANCE and its clients, officers, directors, employees, and affiliates, harmless from any liability, loss, claim and expense, including reasonable attorney’s fees, related to violation of this Agreement or use of the Site.
Disclaimer. THE INFORMATION ON THIS SITE IS PROVIDED ON AN “AS IS,” “AS AVAILABLE” BASIS. USER AGREES THAT USE OF THIS SITE IS AT USER’S SOLE RISK. THIS SITE MAY INCLUDE INACCURACIES OR TYPOGRAPHICAL ERRORS. PREMIER AMBULANCE DISCLAIMS ALL WARRANTIES OF ALL KIND, INCLUDING BUT NOT LIMITED TO ANY EXPRESS WARRANTIES, STATUTORY WARRANTIES, AND ANY IMPLIED WARRANTIES OF: MERCHANT-ABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT. TO THE EXTENT USER’S JURISDICTION DOES NOT ALLOW LIMITATIONS ON WARRANTIES, THIS LIMITATION MAY NOT APPLY TO YOU. USER’S SOLE AND EXCLUSIVE REMEDY RELATING TO USE OF THE SITE SHALL BE TO DISCONTINUE USING THE SITE.
WE DO NOT GUARANTEE, REPRESENT OR WARRANT THAT THE SITE OR ANY OF THE SITE MATERIALS WILL BE FREE OF INFECTION FROM ANY VIRUSES, WORMS, TROJAN HORSES, TRAP DOORS, BACK DOORS, EASTER EGGS, TIME BOMBS, CANCEL-BOTS OR OTHER CODE OR COMPUTER PROGRAMMING ROUTINES THAT CONTAIN CONTAMINATING OR DESTRUCTIVE PROPERTIES OR THAT ARE INTENDED TO DAMAGE, DETRIMENTALLY INTERFERE WITH, SURREPTITIOUSLY INTERCEPT OR MISAPPROPRIATE ANY SYSTEM, DATA OR PERSONAL INFORMATION. YOU ARE RESPONSIBLE FOR THE IMPLEMENTATION OF SUFFICIENT PROCEDURES, FIREWALLS AND CHECKPOINTS WHICH SATISFY YOUR PARTICULAR REQUIREMENTS FOR SECURITY, ACCURACY, AND DATA INPUT AND OUTPUT, AND FOR MAINTAINING A MEANS EXTERNAL TO THE SITE OR THIS SERVER, FOR THE RECONSTRUCTION OF ANY LOST DATA, INCLUDING BUT NOT LIMITED TO ANY DOWNLOADS FROM THE SITE OR THIS SERVER.
Limitation of Liability. UNDER NO CIRCUMSTANCES WILL PREMIER AMBULANCE OR ITS OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, SUCCESSORS, SUBSIDIARIES, DISTRIBUTORS, AFFILIATES OR THIRD PARTIES AFFILIATED WITH THIS SITE OR PROVIDING INFORMATION ON THIS SITE OR VIA OTHER CHANNELS, BE LIABLE OR RESPONSIBLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL (INCLUDING DAMAGES FROM LOSS OF BUSINESS, LOST PROFITS, LITIGATION, OR THE LIKE), SPECIAL, EXEMPLARY, PUNITIVE, OR OTHER DAMAGES, UNDER ANY LEGAL THEORY, ARISING OUT OF OR IN ANY WAY RELATING TO THE SITE, USER’S SITE USE, OR THE CONTENT, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. USER’S SOLE REMEDY FOR DISSATISFACTION WITH THE SITE AND/OR CONTENT IS TO CEASE ALL OF USER’S SITE USE.
User may have additional rights under certain laws (including consumer laws) which do not allow the exclusion of implied warranties, or the exclusion or limitation of certain damages. If these laws apply, the exclusions of limitation in this Agreement that directly conflict with such laws may not apply.
Copyrights and Copyright Agent. All contents of the Site are: Copyright by PREMIER AMBULANCE and/or its clients or affiliates. All rights reserved. If User believes User’s work has been copied in a way that constitutes copyright infringement, please provide a notice containing all of the following information to the Administrator at 260 N Palm St. Ste 200, Brea, CA 92821:
a. An electronic or physical signature of the person authorized to act on behalf of the owner of the copyright interest;
b. A description of the copyrighted work that is claimed to have been infringed upon;
c. A description of where the material that is claimed to be infringing is located on the Site;
d. A current address, telephone number, and e-mail address;
e. A statement that based upon a good faith belief, that the dispute use is not authorized by the copyright owner, its agent, or the law; and
f. A statement made under penalty of perjury, that the above information in the notice is accurate and the signer is the copyright owner or authorized to act on the copyright owner’s behalf.
Applicable Law. User agrees that the laws of the State of California, without regard to conflicts of laws provisions will govern these Terms and Conditions of Use and any dispute that may arise.
Severability. If any provision of this Agreement shall be adjudged by any court of competent jurisdiction to be unenforceable or invalid, that provision shall be limited or eliminated to the minimum extent necessary so that this Agreement will otherwise remain in full force and effect.
HOW TO CONTACT US:
200 N Palm St. Ste 200
Brea, CA 92821