NEMT business card and flyer template: what to print for discharge planners and families

How to use this template

Print one double-sided sheet and one card, and fill in only what you do today. The front is for the person who books rides for patients, such as a discharge planner, social worker, or case manager. The back is for the family who rides. Before you print, call the number on the sheet from a phone that is not yours and confirm that a person answers during the hours you list.

The sheet is a leave-behind for a meeting or a drop-in visit. If you are writing first, the introduction letter comes before it, and how to get facility contracts explains who to ask for at each kind of facility. A discharge team wants one direct number that answers, a real pickup time, and a way to hear back, as the guide to hospital discharge transportation lays out. The wider channels and healthcare marketing limits are in NEMT marketing; this page covers only what goes on paper.

Front of the sheet: for discharge planners and case managers

[Company name] Rides for patients who cannot drive themselves, in [counties or cities]

Rides we carry: [ ] ambulatory [ ] wheelchair, lift or ramp [ ] stretcher [ ] stair-chair help [ ] oxygen carried by the rider [ ] one escort may ride along

Limits: wheelchair width up to [] inches, rider weight up to [] pounds, [no / one flight of] stairs

Area: [counties], and trips up to [__] miles beyond them

Hours: dispatch [days, times]. Hospital discharges: [hours or “every day, 24 hours”]. Holidays: [open / closed / call]

Book: call [direct number, answered by a person] or request online at [address]. Next-day rides need the request by [time].

Same-day and discharge rides: pickup within [__] hours of your call

Return rides (will-call): we arrive within [__] minutes of your call

Who pays: [facility account, private pay, or the rider’s health plan broker]. Rates on request.

On request: certificate of insurance, driver screening summary, one-page monthly on-time report

Your contact: [name, title, direct phone, email]

Print only response times you hit last month. Buyers write their own limits, and the examples differ. MTM Health’s Virginia handbook (approved August 10, 2026) sets will-call returns at 45 minutes from the call and hospital discharges at three hours, with liquidated damages for a missed discharge. Hamilton County, Ohio set 60 minutes from the first call to arrival for an unscheduled will-call. If your number is looser than a buyer’s, say so on the sheet and offer the faster time only where you can staff it.

Back of the sheet: for families

Set this side in large print, which means type of at least 18 points. The rider welcome letter explains the standard from the American Printing House for the Blind and the layout changes that go with it, such as plain fonts, no italics, and no gray. At that size a side holds only a handful of short blocks, so cut the text before you shrink the type.

[Company name]: getting you to your appointment

To book a ride, call [number]. Have ready: the rider’s name, pickup address, the appointment time and place, and how the rider gets around (walker, wheelchair, scooter, or stretcher).

Book at least [__] days ahead. For a ride home from a hospital or clinic, call us when you are ready and we will tell you how long it will be.

If you need to cancel or you are running late, call [number] before the van arrives.

To tell us how we did, call [number] or write [address]. [A person reads every message.]

Free language help: call [number] and say your language. [Languages you cover.]

Call-ahead and cancellation lines work as a complaint sheet too. Hamilton County’s 2025 request asked bidders to keep each vehicle’s license number, the company’s toll-free and local numbers, and the complaint procedure in written form inside every vehicle for handing to riders, and to post large-type complaint signs that account for riders with limited English. A back page like this one can go in the seat pocket as well.

Business card: six fields

A card has room for six items, so choose them in this order.

The name and the phone number should match your broker listings as well. MTM Health’s 2023 provider agreement lets MTM use a provider’s name, address, phone numbers, and description of services in its directory and advertising, and an out-of-date number sends a rider or a planner to a dead line. Leave the back blank for a handwritten name, or print the hours and the lead time you need for a booking.

Claims to leave off

These lines look harmless on a sheet, and each one runs into a federal rule or a contract term.

• Free rides, gifts, or discounts for Medicaid or Medicare riders. A free ride is remuneration under 42 U.S.C. 1320a-7a(i)(6), which counts “transfers of items or services for free or for other than fair market value.” OIG’s 2016 policy statement puts the ceiling for a nominal gift at $15 per item and $75 per patient across a year, and never counts cash or a cash equivalent. Two of the exceptions that apply to free services both rule out advertising: the financial need exception in 42 CFR 1003.110 covers items or services not offered as part of any advertisement or solicitation, and the local transportation safe harbor in 42 CFR 1001.952(bb) requires that the ride not be publicly marketed or advertised. A flyer is advertising either way, so take any free-ride idea to a health care lawyer before you print it. The anti-kickback guide covers gifts to facility staff and referral sources.
• “Medicaid approved,” or the Medicare card design. 42 U.S.C. 1320b-10 bars using the words Medicare or Medicaid, the names CMS and HHS, or their symbols in an advertisement in a way that could be read as approval by, or a link to, those agencies. The statute sets up to $5,000 per violation, HHS’s inflation table puts the current figure at $13,132, each piece of mail counts separately, and a disclaimer does not cure it.
• Program names a contract does not allow. Hamilton County’s request permits a sign such as “We proudly serve Medicaid populations” and bars wording that implies a passenger is on Medicaid. MTM Health’s Virginia handbook keeps the word off the van entirely. See vehicle signage and print the same restraint on paper.
• Medicare Advantage claims. Modivcare’s Mississippi manual attaches Medicare Advantage program terms in which the provider agrees to follow laws and CMS instructions on marketing. If a plan’s vendor sends you its members, read that attachment before you mention the plan.
• Names, stories, or photos of riders. A testimonial needs the rider’s signed authorization, which the rider photo release form records.
• Ambulance wording. MTM Health’s Virginia handbook bars ambulance or EMS wording and the Star of Life on the vehicles of providers without an EMS license. The same words invite questions on paper.

The language line

Print a language line only for languages your dispatchers can serve today. A marketing flyer is not one of the communications that 45 CFR 92.11 requires to carry the formal notice of free language help, which belongs on forms, billing materials, and in the physical locations the rule names. Language access in NEMT explains who is covered, and the language access plan template builds the plan behind the line.

Keeping the promises on the sheet in HealthRide

Every line on the sheet is a promise your dispatchers have to keep. Riders and families can book online, and a text link lets them follow the driver live. Facility staff can request rides and watch each vehicle on a live map. A return trip with no set time keeps its place on the board until the passenger is ready, which is the will-call line on the front of the sheet. See live map.