Pick-Up Location

Address 1: {{claimLevel?.pickupAddressLine1}}
Address 2: {{claimLevel?.pickupAddressLine2}}
City: {{claimLevel?.pickupCity}}
State: {{claimLevel?.pickupState}}
ZIP Code: {{claimLevel?.pickupZip}}

Drop-Off Location

Address 1: {{claimLevel?.dropoffAddressLine1}}
Address 2: {{claimLevel?.dropoffAddressLine2}}
City: {{claimLevel?.dropoffCity}}
State: {{claimLevel?.dropoffState}}
ZIP Code: {{claimLevel?.dropoffZip}}
Transport Reason Code: {{claimLevel?.transportReasonCode}}
Transport Distance Miles: {{claimLevel?.transportDistance}}
Round Trip Purpose: {{claimLevel?.roundTripPurpose}}
Stretcher Purpose: {{claimLevel?.stretcherPurpose}}
Certification Indicator: {{c?.certIndicator}}
Ambulance Cond. Code: {{c?.conditionCodes}}