Authorization for Escort Services a. The Provider, upon the request of an authorized requesting agency or DET facility, shall arrange and provide secure transport and escort services so that Clients are transported from a designated point of origin to a designated point of destination.
b. API may authorize additional transport for:
i. Local, round-trip transportation for Clients when deemed medically necessary, such as for off-campus Dr. Appointments.
ii. One way trips, such as to return a Client home, when deemed medically necessary
c. Documentation for transport must include the following:
i. A notice of detention, an order for an evaluation or a commitment hearing, which consists of one of the following documents completed in full and signed by the appropriate authorizer:
1. A copy of an Alaska Court System (ACS) form: MC-105, Notice of Emergency Detention & Application for Evaluation (XXX);
2. A copy of ACS form MC-305, Order Authorizing Hospitalization for Evaluation (a/k/a, the 72-hour hold); or
3. A Notice from the ACS of a 30-Day, 90-Day, or 180-Day Commitment or Commitment Hearing.
ii. A Travel Authorization for Secure Transport & Escort Services Form (Attachment 1) from the requesting agency or DET facility. The Travel Authorization Form will provide the full name of the Client, date of birth, the type of transportation, and the approved services required including the points of origin and destination. The form must be signed by an agent of requesting agency or DET facility; and
iii. A copy of the “Admission Acceptance Fax Form,” or proof of acceptance from a DET facility or other court-approved hospital.
iv. Other necessary documentation of the Client’s transport activity, to be provided as additional support to each submitted Transport Invoice (Attachment 4), includes the following:
1. A Secure Transport and Escort Services Duty Log (Attachment 2). The Provider is required to keep a duty log, which indicates compliance with either the authorized requesting agency’s or DET facility’s instructions on activities concerning the Patient being escorted; and
Authorization for Escort Services a. The Provider, upon the request of an authorized requesting agency or DET facility, shall arrange and provide secure transport and escort services so that Clients are transported from a designated point of origin to a designated point of destination. Provider should be chosen by the first available to conduct the transport.
b. Documentation for transport must include the following:
i. A notice of detention, an order for an evaluation or a commitment hearing, which consists of one of the following documents completed in full and signed by the appropriate authorizer:
1. A copy of an Alaska Court System (ACS) form: MC-105, Notice of Emergency Detention & Application for Evaluation (XXX);
2. A copy of ACS form MC-305, Order Authorizing Hospitalization for Evaluation (a/k/a, the 72-hour hold); or
3. A Notice from the ACS of a 30-Day, 90-Day, or 180-Day Commitment or Commitment Hearing.
ii. A Travel Authorization for Secure Transport & Escort Services Form (Attachment 1) from the requesting agency or DET facility. The Travel Authorization Form will provide the full name of the Client, date of birth, the type of transportation, and the approved services required including the points of origin and destination. The form must be signed by an agent of requesting agency or DET facility; and
1. API recognizes that law enforcement officers and Department of Corrections does not provide a TA form to providers; and that some hospital facilities use their own EMTALA transfer form.
iii. A copy of the “Admission Acceptance Fax Form,” or proof of acceptance from a DET facility or other court-approved hospital.
iv. Other necessary documentation of the Client’s transport activity, to be provided as additional support to each submitted Transport Invoice (Attachment 4), includes the following:
1. A Secure Transport and Escort Services Duty Log (Attachment 2). The Provider is required to keep a duty log, which indicates compliance with either the authorized requesting agency’s or DET facility’s instructions on activities concerning the Patient being escorted; and
v. It may be requested that when the Provider transports a Client, they carry and deliver sealed documents as instructed by the requesting agency or DET facility.
c. All documents listed above shall remain in the possession of the Escort during transportation.
d. Upon completion of the escorted patient travel, the Provider will submit the following documentation to the State: Applicable Court Order, an DFCS pre-approved...
