NEMT rider profile form: mobility, equipment, entrances, and contacts in one record
A NEMT rider profile is the standing record dispatch pulls into every booking: how the rider moves, the device that comes along with its width and combined weight, whether they transfer, who rides with them, how to communicate, which door and parking spot to use, who to call in an emergency, and each payer's member ID. Diagnoses, Social Security numbers, and card numbers stay off it.
On this page
How to use the profile
Keep one profile per rider. Start it at the first booking and reuse it on every ride after that. The trip request form then only has to capture what changes from ride to ride: the date, the appointment, the destination, and the authorization.
- Fill it in with whoever knows the rider best. A daughter, a case manager, or a facility nurse often knows the chair model and the right door better than the rider does.
- Ask about mobility in plain questions. “Wheelchair” alone does not tell dispatch whether to send a lift van or a sedan with room for a folded chair. Ask what the rider can do: stand, pivot, climb a step.
- Split what each person sees. Dispatchers and drivers need the travel details. Billing staff need the member IDs. Nobody needs everything.
- Date every review. A profile nobody has checked in two years is a guess, and a guess sends the wrong vehicle.
The form
A. The rider
| Field | Entry |
|---|---|
| Full legal name, and the name the rider goes by | |
| Date of birth (tells apart two riders with one name) | |
| Main phone; messages may be left: Yes / No | |
| Backup phone, or a person to try when the main phone is off | |
| How to reach the rider (circle): call / text / call a named person first | |
| Home address with unit or apartment number | |
| Lives (circle): alone / with family / in a facility (name it) |
B. Payers and member IDs
| Payer | Program or plan name | Member ID | Notes |
|---|---|---|---|
| Medicaid | Rides booked through (circle): broker / health plan / state | ||
| Medicare Advantage plan | Plan covers rides: Yes / No / Not sure | ||
| Facility or agency that pays | Account or PO number | ||
| Rider or family pays | Card on file: Yes / No (never the card number) |
C. How the rider moves
| Question | Answer |
|---|---|
| Walking (circle): unaided / cane / walker / needs an arm to hold | |
| Chair (circle): none / manual / transport chair / power chair / scooter | |
| Chair width and length in inches; seated height if the rider is tall | |
| Rider and chair together, in pounds | |
| Crash-tested WC19 chair with marked tiedown points (circle): Yes / No / Not sure | |
| Can stand and pivot into a vehicle seat (circle): Yes / No / With help from ___ | |
| Rider prefers to travel (circle): in the chair / in a vehicle seat | |
| Travels lying down: Yes / No. Can sit upright for the whole ride: Yes / No | |
| Help between door and vehicle (circle): curb to curb / door to door / hand to hand | |
| For hand to hand, who receives the rider at each end |
Three notes on those answers:
- Record abilities, not a vehicle type. Missouri’s Medicaid program counts a manual chair user who can stand or pivot without help as ambulatory, and sends a wheelchair vehicle for power chair users and for manual chair users who cannot transfer. Another program may draw the line elsewhere. What the rider can do stays true either way. The glossary explains each level of service.
- WC19 saves the driver time. The University of Michigan’s Ride Safe guide explains that a chair built to the voluntary WC19 standard comes with four tiedown points that were crash tested and carry a hook symbol. Without them, the driver has to find solid frame points for the tiedowns.
- Hand to hand means a named person. MTM Health’s Virginia handbook defines it as passing the rider from someone at the pickup to staff, a relative, or another responsible adult at the other end. Its examples include riders living with dementia or a developmental disability. See our guide to riders with dementia.
D. Equipment and people riding along
| Question | Answer |
|---|---|
| Oxygen (circle): none / portable tank / portable concentrator. Rider brings the supply: Yes / No | |
| Other items that ride along: walker, folded chair, bags, supplies | |
| Service animal: Yes / No | |
| Escort or family member who usually rides (name, relationship, phone) | |
| Escort required by the payer’s rules (for example, a child): Yes / No | |
| Any children on the ride, their ages, and whose car seats they use | |
| Seats and wheelchair spaces needed in total |
Riders may bring portable oxygen and service animals under 49 CFR 37.167. Georgia’s Medicaid rules put supplying and running the oxygen on the member, because NEMT vehicles and drivers are not equipped to give it. Programs also set rules for children. Missouri requires a rider under 17 to travel with a parent or guardian, or another adult the parent names, and MTM Health’s Virginia handbook has parents supply safety seats for children through age seven.
E. Communication
| Question | Answer |
|---|---|
| Preferred language; interpreter needed: Yes / No | |
| Hearing (circle): hearing aids / uses a TTY or relay service / text only | |
| Vision (circle): low vision / blind; needs guidance to the vehicle: Yes / No | |
| May forget the ride: Yes / No. Call ___ before pickup | |
| What helps the ride go well, in plain words (no diagnosis) | |
| May be left alone at the destination: Yes / No |
Our guide to language access in NEMT covers phone interpreters and translated notices.
F. Places
| Detail | Home | Regular stop 1 | Regular stop 2 |
|---|---|---|---|
| Name of the place | |||
| Door to use: front, side, back, ramp, lobby | |||
| Where the van can pull up or park | |||
| Number of steps to the curb; handrail or ramp | |||
| Door codes, call box, or a desk to check in at | |||
| Person on site, with phone |
A street address gets the van to the block, and this table gets it to the right door. Rides that repeat on set days belong on a standing order form that points back to this profile. Our guide to pickup address problems shows how to pin down large campuses and apartment complexes.
G. Emergency contacts and permissions
| Field | Entry |
|---|---|
| Emergency contact 1: name, relationship, phone | |
| Emergency contact 2: name, relationship, phone | |
| People the rider allows staff to discuss rides with | |
| Legal decision-maker on file (for example, a guardian): name and phone | |
| If the rider does not come out at pickup, call first: ___ |
H. Review
| Field | Entry |
|---|---|
| Profile started: date and staff initials | |
| Last reviewed: date, and with whom | |
| What changed at the last review | |
| Next review due |
What to leave off the profile
- Diagnoses and medical history. Write what the ride requires: the chair, the oxygen, the help at the door. Under HIPAA’s minimum necessary rule, 45 CFR 164.502(b), a covered provider keeps what it uses, shares, and asks for to what the task calls for.
- Social Security numbers. The Medicaid ID or the plan’s member ID is what a payer uses to find the rider.
- Card numbers and security codes. Card details belong on a separate credit card authorization form, kept away from dispatch.
- Labels and opinions. “Difficult” tells a driver nothing useful. “Call 10 minutes ahead; needs time to lock the door” does. Riders can also see what you wrote: Missouri gives every rider the right to request and receive a copy of their transportation records.
- Old answers next to new ones. When needs change, replace the entry and date it, so a driver never reads two versions.
The rules behind the fields
| Field | Rule | Where it comes from |
|---|---|---|
| Rider and chair weight | Lifts built to the ADA standard carry at least 600 pounds; a provider may decline a rider and chair whose combined weight is over its lift’s rating | 49 CFR 38.23, 49 CFR 37.165 |
| Travel in the chair or a seat | Staff may recommend a transfer but cannot require it, and may require the chair to be secured | 49 CFR 37.165(c) and (e) |
| How to reach the rider | Covered providers accommodate reasonable requests to be contacted by other means or at other places | 45 CFR 164.522(b) |
| People who can be told about rides | Details may go to relatives, friends, or others the rider names, as far as their role in care or payment | 45 CFR 164.510(b) |
| Language | Language help is free and uses qualified interpreters; minor children may interpret only in an emergency | 45 CFR 92.201 |
| Weight on the manifest | For Virginia fee-for-service trips from October 1, 2026, MTM Health lists each member’s weight, mobility device included, on the trip manifest | MTM Health Virginia provider handbook |
The HIPAA side of family calls is covered in more depth in our guide to HIPAA and family members.
Keeping rider profiles in HealthRide
In HealthRide, each rider’s needs are filled in automatically from their profile when you book, and wheelchair, stretcher, and oxygen needs are matched to a suitable vehicle on the dispatch board. Upload your rider list from a spreadsheet or your old software and HealthRide matches the columns for you. Rider details stay off phone lock screens, and every team member sees only what their role allows.
Frequently asked questions
- How is a rider profile different from a trip request form?
- A profile holds the facts that stay the same from ride to ride. A trip request holds the facts of one ride. Mobility, equipment, contacts, entrances, and member IDs live on the profile and fill each booking. The date, the appointment time, the destination, and the broker's trip number belong to the single ride. With the two kept apart, a new walker gets entered once instead of on every future trip.
- Why record chair size and the weight of rider and chair together?
- Lifts and securement areas have limits. The federal ADA vehicle standard asks for a lift rated for 600 pounds or more, with a platform of 30 by 48 inches or larger. Under 49 CFR 37.165, a rider and chair bigger or heavier than that must still be carried if the lift and van can take them, and a provider can say no only when the pair outweighs the lift's specifications or carrying it is shown to conflict with legitimate safety requirements. For Virginia fee-for-service trips from October 1, 2026, MTM Health's manifests show each member's weight with the mobility device counted in.
- Can a driver require a wheelchair user to move into a van seat?
- No. Under 49 CFR 37.165, staff can recommend moving to a van seat, and the choice stays with the rider. The same rule lets a provider require that the chair be secured, and bars turning a rider away because the chair does not tie down well. Record the rider's choice on the profile. The University of Michigan Transportation Research Institute's Ride Safe guide calls moving to a vehicle seat and belt generally the safest option when the transfer is practical.
- Who can dispatch talk to about a rider's rides?
- The people the rider names, and anyone with legal authority over the rider's health care decisions. HIPAA lets a covered provider share the details that bear on a relative's, friend's, or other named person's part in the rider's care or payment, when the rider agrees or does not object. HIPAA treats someone who can legally make the rider's health care decisions the same as the rider. List both on the profile so nobody guesses on the phone.
- How often should a rider profile be updated?
- At least once a year, and again after any change in how the rider gets around: a hospital stay, a fall, a new chair, or a move. Programs expect those changes. In Missouri, the broker switches off a rider's standing order once it hears of a hospital stay, a new one is arranged after discharge, and standing orders other than dialysis are recertified with the broker every 90 days. Put the date of the last review on the profile.
- What if the rider speaks limited English?
- Write the preferred language on the profile and plan for free language help. The federal Section 1557 rule, which covers health programs that receive federal financial assistance directly or indirectly, requires qualified interpreters at no cost to the person. It bars asking riders to bring their own interpreter and relying on a minor child to interpret outside an emergency. Relatives who ride along are not a substitute for an interpreter unless the rider asks for that in private.
