HomeMy WebLinkAboutC.054.93011_1311� 2006 N
negotiate for an acceptable rate, and if agreement is not reached within thirty days after the
rejection by the county, then the county may terminate the franchise; and further, any rate
increase sought by the franchisee will be filed with the county 60 days before it is to be
effective, and if the county takes no action or approves the increase, it will go into effect on
the date specified in the filing. If the county takes action by resolution to disapprove the
increase, the proposed rate increase shall not be effective.
(b) No ambulance service shall attempt to collect rates on emergency calls until the patient has
reached the point of destination, has received medical attention and is in a condition deemed
by the physician fir to consult with the ambulance service, but such service may attempt to
collect rates with the family or guardian of the patient once the patient is in the process of
receiving medical attention.
(c) On non -emergency calls, or calls where a person requires transportation to a non -emergency
facility, attempts to collect payments can be made before the ambulance begins its trip.
Sec. X-?. Reserved.
Iredell County Ambulance Service
Rate & Charge Declaration/Declination Form
Please complete the appropriate section below (print or type):
❑ As an entity franchised to provide ambulance service in Iredell County,
seeks to charge the
fees set forth below as signed by the organization's chief administrator this
day of 2006.
Basic Life Support
$
Advanced Life Support
$
Out of County Mileage
$
ALS Treatment, No Transport
$
Two or more patients (BLS or ALS)
Other:
$
❑ As an entity franchised to provide ambulance service in Iredell County,
does not seek to charge
a fee for ambulance service as signed by the organization's chief administrator this
day of 2006.
The above listed ambulance service declares/declines ambulance fees as indicated herein.
Signed: Date:
Chief Administrator
Signed: Date:
Chairman to the Board of Commissioners
Iredell County, North Carolina
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