Billing Requirements for Crew Paperwork and ePCRs

All documentation and report requirements reflect the same standards set by our billing company in order to adequately bill and code every call, so that GEMS can collect on each call we take. Failure to adhere to proper documentation standards will result in immediate disciplinary action.

Requirements for Documentation Envelopes

The following fields on the envelope are required and must be filled out:

  • The date your shift starts
  • Your Unit number
  • Names of Crew Members
  • FULL, COMPLETE CAD numbers and check boxes filled for each applicable document obtained for each call.

Requirements for Paperwork

Each call must have the following forms with the FULL, COMPLETE CAD number written legibly in the top, right-hand corner.

  • A Face Sheet is required for every call. The following forms are required when applicable to the call:
    • PCS Form
    • VA Auth form
    • EKG Strips
      • Pictures and records of EKG strips are required for all calls where the patient is placed on the cardiac monitor during transport for any reason. This is also a documentation requirement per SNHD Protocol.

For calls where normal documentation may not be available, make sure to get photocopies of the patients’ Driver’s License/ID, and insurance cards if applicable.


The pictures you attach may not always upload correctly when you post your ePCR, which is why it is important to turn in all required hard copies of patient paperwork.

Requirements for ePCRs

  • Response Urgency:
    • This field must be “Immediate” for all unscheduled calls and quick care calls.
    • Only select “Non-Immediate” for scheduled calls.
  • Reason for Transfer:


  • Good examples specify the medical necessity of the transport and should answer the following question: “Why is the patient going to the (or another) hospital?”. If you still need to reference reasons for transfer, read a PCS form.
    • “Pt is being transferred to receiving facility for specialist (be specific) not available at sending facility.”
    • “Pt requires (specific medical interventions: O2, IV medications, EKG monitoring, etc.) during transfer”
  • Bad examples are those that are too vague and do not spell out the medical necessity or the reason for transfer.
    • “Pt is going to ER for higher level of care”
    • “Pt is being transported for monitoring en route”
  • You must accurately list all treatments and interventions done during transport in your narrative. (Patient placed on cardiac monitor, patient placed on O2, etc)
  • Signatures required for each call:
    • PATIENT: The patient’s signature must have the following reasons:
      • HIPAA acknowledgment/Release
      • Permission to Transport
      • Permission to Treat
      • Release for Billing

You must ALWAYS attempt to get the patient’s own signature. If for any reason the patient ABSOLUTELY CANNOT sign for themselves, you must state the reason in your Narrative, and have the Healthcare Provider (or yourself under EMS Crew Member as an absolute last resort) sign as a Patient Representative with the additional following reasons:

  • Transfer of Patient Care
  • Patient/Medical Necessity Unable to Sign
  • You must also select the most appropriate reason under the “Why Can’t The Patient Sign?” section.


    • You MUST obtain the signature of the HCP you are turning the patient over to with the following reasons:
      • Transfer of Patient Care
    • If you are unable to have a nurse sign, you may ask the charge nurse.
    • Obviously, you need to sign your own PCR. Your signature needs to be present.


Effective October 18, 2020:

  • Any reports or documents that do not adhere to the documentation guidelines will be subject to disciplinary action for Improper Documentation.
  • Any reports requiring correction will still be flagged in Image Trend and you will be sent a message via email to correct them. Image Trend is a web-based program that can be accessed at any time with your credentials on any smart phone, computer, or tablet.
  • If you do not correct your report within 48 hours of it being flagged, you will be subject to further disciplinary action on top of any disciplinary action received for Improper Documentation.