NEMT daily manifest template: a printable driver run sheet
A NEMT daily manifest lists one driver's shift in run order: every pickup, with the pickup time or window, the appointment time, addresses, the rider, the level of service and assistance, mobility equipment, escorts, and the trip or authorization number. Dispatch prepares it before the shift, and the driver notes actual times and changes as the day runs.
On this page
How to use this template
Dispatch fills in the planned columns before the shift, one manifest per driver per day. The driver carries it, notes actual times and changes, and hands it back at the end of the shift.
- One line per leg. A round trip is two lines, and a will-call return gets its own line with no pickup time.
- In run order. List stops in the order the driver will do them, not the order they were booked.
- Print time. Write the time you printed it in the header. When the schedule changes after printing, the driver knows their copy is out of date.
- Keep it with that day’s trip records. If the driver writes actual times on it, it becomes part of your documentation, and your trip log retention rules apply.
Only print what the driver needs to do the job. HIPAA’s minimum necessary rule applies to paper as much as screens, so leave diagnoses and anything the driver does not need off the sheet.
The template
Shift header
| Field | Entry | Field | Entry |
|---|---|---|---|
| Date | Printed at (time) | ||
| Driver | Dispatcher and phone | ||
| Vehicle or unit number | License plate | ||
| Seats and wheelchair positions | Shift start and end |
Stops in run order
| Stop and trip ID | Pickup window and appointment time | Rider, phone, and needs (use codes below) | Pickup address and drop-off address | Actual arrive and depart |
|---|---|---|---|---|
Codes for the needs column
| Code | Meaning |
|---|---|
| AMB | Ambulatory, rider walks to the vehicle |
| WC | Wheelchair, rider stays in their chair |
| STR | Stretcher |
| O2 | Rider travels with portable oxygen |
| SC | Stair chair needed |
| C2C | Curb-to-curb assistance |
| D2D | Door-to-door assistance |
| H2H | Hand-to-hand, rider handed to a named person |
| ESC | Escort or attendant riding along |
| WCL | Will-call return, no set pickup time |
Open will-call returns
| Rider and trip ID | Pickup location | Rider called at (time) | Assigned driver and time |
|---|---|---|---|
Changes during the shift
| Time | Trip ID | Change (added, canceled, no-show, time change) | Approved by |
|---|---|---|---|
End of shift
| Field | Entry | Field | Entry |
|---|---|---|---|
| Trips completed | No-shows | ||
| Cancellations | Ending odometer | ||
| Driver signature | Dispatcher review |
What brokers and auditors look for
Brokers check that each trip ran the way it was authorized: the right rider, the right time, the right vehicle, and the right level of help. The manifest is where those details reach the driver, so gaps here turn into complaints and denied trips later.
- Level of assistance. Virginia’s Medicaid rules require drivers to provide the level of assistance shown in the manifest: curb-to-curb, door-to-door, or hand-to-hand. CareOregon defines hand-to-hand as a full escort where the driver hands the rider to a specific person and checks them in.
- Authorized changes only. CareOregon providers may not change pickup times, appointment times, addresses, or vehicle type without broker approval. Trips not provided as authorized are not paid.
- Timing rules. CareOregon drivers may not pick riders up before the scheduled time or window unless the rider chooses to go early, and may not drop riders more than 15 minutes before the facility opens. Drivers wait at least 15 minutes after the scheduled pickup time before reporting a no-show.
- Late rides. Virginia treats a ride as late 15 minutes after the scheduled pickup time. Missouri tells riders to call the broker’s ride line when a ride is more than 15 minutes late.
- Will-calls. Virginia gives the provider up to 45 minutes to arrive after a will-call return is requested.
- Stored data. CareOregon requires both the broker and the provider to store the trip data sent to the provider.
Brokers also expect you to confirm trips ahead of time. MTM tells its providers to confirm the pickup time with the rider the day before the trip. Our guide to the NEMT dispatch workflow covers how the manifest fits into the rest of the day.
Common mistakes
- Round trips on one line. The return leg gets lost, especially when it is a will-call.
- No assistance level or equipment. The wrong vehicle shows up, or a driver who planned curb-to-curb finds a hand-to-hand rider.
- No appointment time. Without it, the driver cannot tell which pickups have slack and which cannot slip.
- Too much personal information. Diagnoses, Medicaid ID numbers, and notes the driver does not need do not belong on a sheet that rides on the dashboard.
- Side deals on timing. A driver who agrees to a new pickup time with the rider, without dispatch, can turn a paid trip into an unpaid one.
- Stale copies. A manifest printed at 6 a.m. can be out of date by 9 a.m. Mark changes in the change log and call the driver.
Will-call returns change the plan during the day by design. See how to handle NEMT will-call trips for ways to plan capacity around them.
Doing it faster
In HealthRide, dispatch builds each driver’s day on the dispatch board, or Ryder Go plans and assigns the whole day in one click. The driver app shows the run in order, and flexible will-call returns hold their place on the board and activate the moment the passenger is ready.
Frequently asked questions
- How is a manifest different from a trip log?
- The manifest is the plan for the day, prepared by dispatch before the shift. The trip log is the record of what actually happened, filled in by the driver on each leg. Drivers can write actual times on the manifest too, but keep a separate signed trip log if your broker or state requires one.
- What should a NEMT manifest include?
- At minimum, each leg's trip or authorization number, the rider's name, the scheduled pickup time or window, the appointment time, pickup and drop-off addresses, the level of service, the level of assistance (curb-to-curb, door-to-door, or hand-to-hand), mobility equipment, and any escort. Add the rider's phone number and special instructions the driver needs.
- Can a driver change a pickup time with the rider directly?
- Not on broker trips. CareOregon's rules say providers may not change pickup times, appointment times, addresses, or vehicle type without broker authorization, and trips not provided as authorized are not paid. The driver should call dispatch, and dispatch should get the change approved.
- How do I show will-call returns on a manifest?
- List each will-call return as its own line with no pickup time, and keep a separate section for open will-calls so nobody forgets them. When the rider calls, dispatch assigns the pickup and writes in the time. Virginia's Medicaid program gives the provider up to 45 minutes to arrive after a will-call is requested.
- Can drivers use an electronic manifest instead of paper?
- Yes. CareOregon requires providers to have a computer and internet connection that can receive ride assignments, and requires drivers to have a phone or tablet that receives them too. In Virginia, providers view and download Modivcare manifests online. Paper still works as a backup when a phone dies or loses signal.
- Is a printed manifest a HIPAA risk?
- It can be, because it lists riders' names, addresses, and medical destinations. HIPAA's minimum necessary rule means printing only what the driver needs. CareOregon tells drivers never to leave papers with member information where others can see them. Collect paper manifests at the end of the shift and store or shred them.
