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Pay Your Bill
Jessamine County Ambulance Service contracts with Credit Bureau Systems Inc. to provide Ambulance Medical Billing and Medical Accounts Receivable Systems. If you would like to pay a bill you can click the picture or “Payment Portal” below and you will be redirected to their patient payment portal.
Patient Specific Forms
Jessamine County EMS Privacy Practices
This notice of privacy practices describes how Jessamine County EMS may use and disclose your Protected Health Information (PHI) in the course of treatment, payment, and other health care operations.
Jessamine County Ambulance Fee Schedule
The following fee schedule is posted here to comply with 202 KAR 7:575. The Jessamine County EMS fee schedule is based on a median of regional agencies.
Advanced Beneficiary Notice – Medicare
The Advanced Beneficiary Notice (ABN) lists the items or services that Medicare isn't expected to pay for, along with an estimate of the costs for the items and services and the reasons why Medicare may not pay.
Physician Certification Statement
The Physician Certification Statement (PCS) is the written order certifying the medical necessity of non-emergency ambulance transports. This version of the document is required specifically for Jessamine County EMS transports.
EMS Do Not Resuscitate Order
The Kentucky EMS Do Not Resuscitate (DNR) guides EMS in an event of cardiac or respiratory arrest to not perform CPR or other life-saving interventions. The original, completed Kentucky EMS DNR must remain with the patient and be presented to EMS upon their arrival.
Medical Orders for Scope of Treatment (MOST) Form
MOST for records wishes for medical treatment regarding CPR, medical interventions, and fluid and nutrition administration. The original, completed MOST form must remain with the patient and be presented to EMS upon their arrival.