Free NEMT templates
Printable logs, checklists, and forms built around what brokers and state rules actually ask for. No signup. Print them or save them as a PDF.
Dispatch
6 templates
- 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 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 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 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.
Drivers
5 templates
- Driver drug and alcohol testing policy: fill-in template for NEMT companiesFill-in drug and alcohol policy for NEMT drivers: test types, DOT versus company testing, marijuana under state law, consequences, and a signed acknowledgment.
- NEMT driver file checklist: what to keep on every driverA free printable NEMT driver file checklist: license, driving record, background check, exclusion checks, training certificates, and a renewal tracker.
- NEMT driver job description you can post todayCopy-ready NEMT driver job description with duties, requirements, physical demands, schedule, pay fields, an equal opportunity statement, and pay-range rules.
- NEMT driver onboarding checklist: from offer letter to first solo tripA free printable NEMT driver onboarding checklist: screening, required training, vehicle orientation, ride-alongs, 30 and 90 day steps, and a trainer sign-off.
- NEMT driver training log: prove each driver's courses at audit timePrintable NEMT driver training log with course, trainer, date, hours, expiration, and sign-off columns, plus a group roster and the courses brokers ask about.
Vehicles
4 templates
- Business mileage log for NEMT vehicles: the IRS record, van by vanPer-van NEMT mileage log you can copy: shift odometer readings, business and personal miles, trip purpose, and the IRS record rules that make it stand up.
- NEMT vehicle inspection checklist: a free daily pre-trip formA free printable NEMT pre-trip inspection checklist: brakes, lights, tires, safety kits, seat belts, the wheelchair lift, tiedowns, and a sign-off block.
- Vehicle maintenance log for NEMT vans: service, lift checks, and repairsA per-van NEMT maintenance log: date, odometer, work done, lift and ramp service with cycle counts, parts, shop, cost, and next due, plus the rules behind it.
- Wheelchair securement checklist for NEMT driversA free printable wheelchair securement checklist for NEMT drivers: four-point tiedowns, lap and shoulder belt fit, WC19 securement points, and unloading steps.
Billing
4 templates
- Credit card authorization form for NEMT ridesCard authorization form for NEMT rides to copy and use: cardholder consent for future and repeat rides, no-show and cancellation fees, and safe storage.
- NEMT invoice template with the line items facilities expectFill-in NEMT invoice for facility and private-pay customers: a row per trip leg with date, reference, addresses, miles, base, mileage, wait, extras, and terms.
- NEMT rate sheet template for private pay and facility contractsA free fill-in NEMT rate sheet: base rates by level of service, loaded mileage, wait time, add-on fees, cancellation and no-show charges, and payment terms.
- Service agreement template for hospitals, nursing homes, and clinics that book ridesA free facility transportation agreement: services and levels, booking and notice, rates and extras, invoicing, cancellations, insurance, BAA, and termination.
Compliance
3 templates
- NEMT broker credentialing checklist: every document to have readyA free NEMT broker credentialing checklist: company, insurance, vehicle, and driver documents, the steps MTM and Verida use, and a submission tracker.
- NEMT complaint log template: track every complaint to resolutionFree NEMT complaint log with the columns brokers ask about: date, rider, trip, type, response, corrective action, and closed date, plus a monthly review.
- NEMT incident report template: accidents, falls, and injuriesA free printable NEMT incident report for accidents, falls, securement problems, and injuries, with the reporting deadlines Modivcare, MTM, and New York set.