Free NEMT Templates: Trip Logs, Checklists, and Forms

Dispatch

25 templates

Assisted living transportation policy template: scheduled trips, medical appointments, fees, and escortsA fill-in resident transportation policy for assisted living: schedule, medical rides, fees, escorts, wheelchairs, cancellations, and outside rides.
HIPAA authorization form for NEMT riders: letting a family member or caregiver book and hear about ridesA HIPAA authorization form for ride companies: who may book, change, and hear about a rider's trips, with every required element and a revocation record.
HIPAA fax cover sheet: a fill-in sheet for ride companies, and what it can and cannot protectA fill-in HIPAA fax cover sheet for ride companies, what federal law requires on it, and why checking the fax number matters more than any notice.
Holiday schedule notice for facilities and riders: a fill-in letter for closures and changed hoursA fill-in holiday closure notice for ride companies: a letter for facilities, a plain notice for riders, the last booking day, and who changes a standing ride.
Hospital discharge ride checklist for case managers and dispatchersDischarge ride checklist for case managers and dispatchers: level of service, equipment, oxygen, weight, steps at home, the booking call, and after-hours rides.
Informed refusal form for NEMT riders: a record of a refused seat belt, securement, transfer, escort, or rideFree informed refusal form for NEMT riders: record what was declined, what the driver offered, who was told, and which refusals mean the van does not move.
Lost and found log for a ride company: what was left behind, who found it, and when it went backA fill-in lost and found log for a ride company: item, contact and return parts, safe voicemail wording, and the hold rules in New York and Savannah, Georgia.
Monthly operations report for a NEMT owner: trips, on-time, money, and problems on one pageA one-page NEMT monthly report for owners: trips by payer and level, on-time and late reasons, driver hours, revenue per vehicle hour, denials, and days in A/R.
Monthly transportation report for a facility account: trips, on-time, and issuesA monthly report for each facility you drive for: rides by type, on-time pickups and arrivals, return waits, missed rides and appointments, and invoices.
NEMT daily manifest template: a printable driver run sheetA free printable NEMT daily manifest: every stop in order with pickup windows, appointment times, rider needs, and addresses, plus will-call and change logs.
NEMT dispatch log template: the day's changes, delays, and decisionsFree NEMT dispatch log: timed entries for reassignments, late alerts, breakdowns, cancellations, broker calls, and incidents, showing who decided each change.
NEMT dispatcher checklist: before, during, and after each dayA free NEMT dispatcher checklist for the night before, the first hour, the rest of the day, and close-out, with the broker timing standards behind each task.
NEMT dispatcher job description: duties, qualifications, schedule, and a pay range to postA ready-to-post NEMT dispatcher job description: duties, broker portal work, qualifications, phone-heavy conditions, a BLS pay line, and overtime status.
NEMT no-show policy template: fill-in-the-blank wordingA free fill-in-the-blank NEMT no-show and late cancellation policy: wait times, driver and dispatch steps, private-pay fees, exceptions, and sign-off.
NEMT rider profile form: mobility, equipment, entrances, and contacts in one recordFree NEMT rider profile form: mobility and chair size, transfers, escorts, language, entrances, parking, emergency contacts, payer IDs, and what to leave out.
NEMT rider satisfaction survey: ten questions and how to use the answersFree NEMT rider satisfaction survey: ten questions on timing, drivers, vans, safety, and booking, plus a facility version, accessible formats, and follow-up.
NEMT standing order form: one page for every repeating rideA free NEMT standing order form: weekly days, chair or appointment times, start and end dates, facility contact, authorization, and a change log on one page.
NEMT trip log template: a free printable log for every rideA free printable NEMT trip log with the fields Medicaid programs and brokers check: pickup and drop-off times, odometer readings, addresses, and signatures.
NEMT trip request form: every detail to collect when a ride is bookedFree NEMT trip request form: rider, mobility and equipment, entrances, appointment and return times, payer, authorization, and anyone riding along.
No-show letter to a rider: the missed trips, the rules that apply, and how to cancel in timeFill-in no-show letters for riders: a Medicaid version and a private-pay version, with the missed trips, the cancel rule, and what to leave out.
Passenger conduct policy template: the rules riders agree to and the steps before a ride is refusedFill-in passenger conduct policy for NEMT riders: belts, smoking, weapons, abuse toward drivers, the ADA line, warnings, telling the broker, and records.
Permission to transport a child: the parent consent form for a minor's rideA fill-in parent consent form for a child's medical ride: who rides along, who meets the child, the car seat, health alerts, and two states' age rules.
Resident outside appointment log for nursing homes and assisted living: ride, escort, paperwork, and returnA printable log for staff to record each outside appointment: the ride booked, the escort, what went along, the return, and the results and orders brought back.
Section 1557 notice of nondiscrimination for ride companies: the model text and the language help noticeFill-in Section 1557 notices for a Medicaid-paid ride company: nondiscrimination, language help, where each goes, and which parts courts blocked.
Welcome letter for new riders: pickup windows, waiting, cancelling, and who to callA fill-in welcome letter for new NEMT riders with a large-print copy: pickup window, how long the driver waits, cancelling, who may ride along, and who to call.

Drivers

27 templates

Vehicles

19 templates

Billing

24 templates

Compliance

27 templates