Can a card slip or an invoice serve as the receipt?

No. An invoice asks for money before it is paid. A card slip is the processor's record of one charge and names no ride. A receipt is your own record that a payment arrived and which rides it covered. Send one for every payment a private-pay rider or family makes, even when an invoice or a card slip already exists.

What does a rider need on a receipt to claim an HSA or FSA?

A health FSA asks the rider for a written statement from an independent third party that the expense was incurred and its amount, plus the rider's own statement that no other plan paid it (IRS Publication 969). A receipt from your company, which is not the rider, shows the payer, the date, each ride, and the amount, which is what the first statement has to carry. The plan administrator decides what it accepts. A line for anything another payer covered lets the rider sign the second statement truthfully.

Which date goes on the receipt, the ride date or the payment date?

Both, in separate fields. The payment date is the day your company received the money, and the ride date is when the expense was incurred. IRS Publication 502 counts a card charge in the year it is made, but it generally leaves out payments made this year for care received in a future year. Publication 969 says a health FSA reimburses expenses incurred during its coverage period and cannot make advance reimbursements of future or projected expenses. A late-December payment for January rides fits neither rule, so show the rides on the receipt only once they have been taken.

What should stay off a ride receipt?

Leave off the diagnosis, the reason for the visit, any Medicaid or insurance ID number, a Social Security number, and the full card number. Publication 969 asks for a statement that the expense was incurred and its amount, so a diagnosis adds nothing. For a card payment, print no more than the last four digits. Federal law bars more than the last five digits, and the expiration date, on an electronically printed receipt handed over at the point of sale.

Do I give a receipt for a Medicaid ride?

Usually not, because the rider pays nothing for a covered ride. The state plan's payment is payment in full, plus any cost sharing the plan requires of the member (42 CFR 447.15). If the plan requires a copay and you collect it, give a receipt for that amount. The rest of a covered ride is billed to the program or broker.

What if a receipt has an error or the money is returned?

Leave the original alone. For a mistake, issue a corrected receipt with a new number that says it replaces the old one, and note the replacement in your receipt log. For money returned, issue a refund receipt that cites the original number and shows the amount and date. A receipt that vanishes or gets overwritten cannot be explained later.

How long should I keep copies of receipts?

Keep each copy with the invoice and trip record behind it. The IRS lists receipt books, deposit slips, invoices, and credit card charge slips among the documents that support gross receipts, and the usual period for income tax records is 3 years after the return is filed, or 7 years when a bad debt deduction is claimed. A broker or facility contract can require longer.

Ride payment receipt template: what a private-pay rider needs for HSA, FSA, or tax records

Updated October 6, 20266 min read

Overview

A ride payment receipt confirms that your company received money for specific rides. It carries your legal name and address, a receipt number, the date paid, who paid, each ride with its date, route and service level, the amount, and the payment method. An invoice asks for payment and a card slip shows only a charge, so neither works as a substitute.

On this page

How to use this receipt

A receipt goes out after the money arrives and says what the money paid for. The invoice template is the document that asks for payment, and this one closes the loop.

Write one receipt per payment. A family that pays for a week of rides in a single card charge gets one receipt that lists every ride. A deposit gets its own receipt, and the receipt for the final payment shows the deposit as already paid.
Send it the day the money arrives. A text with a link or an emailed PDF is enough. Use the same layout every time so a rider’s tax preparer sees one familiar format.
List rides one leg at a time. Each one-way trip leg gets a row, so an appointment with a ride home takes two.
Skip covered Medicaid rides. The program’s payment is payment in full, so there is usually nothing for the rider to receipt.
Let the HSA and FSA page decide eligibility. Which rides qualify, and whose fares count, is explained in the HSA and FSA guide. This page is the form.

The receipt

Item	Entry
Receipt number (in sequence, never reused)
Date payment received
Company legal name, and DBA if any
Address, phone, and email
Tax ID (an EIN only, added if the rider’s plan administrator asks)

Paid by

Item	Entry
Name of the person who paid
Relationship to the rider
Rider, if different
Phone or email where this receipt was sent

Rides this payment covers

One row for each one-way leg. Name the medical destination, such as the clinic, hospital, or dialysis center, and leave the reason for the visit off.

Ride date	From and to	Service level	Charge
			$
			$
			$
			$

Payment

Item	Amount
Total charges for the rides above	$
Covered by another payer (name the payer)	$
Paid earlier (receipt numbers)	$
Amount received with this receipt	$
Balance still owed	$

Method	Detail
Card	Last four digits only: ____
Check	Check number: ____
Cash	Received by (staff initials): ____
Bank transfer or pay link	Reference: ____

Footer text for every receipt

This receipt confirms a payment. It is not an invoice and asks for nothing more.
Questions about this receipt: (name, phone, email).
A refund or correction is shown on a separate receipt that cites this number.

An example, with made-up numbers

A son pays by card for his father’s wheelchair rides to a clinic. The family paid a $50 deposit when booking, under receipt R-0381. The charge is $48 per one-way leg, and two round trips ran.

Ride date	From and to	Service level	Charge
Oct 5	Home to Valley Clinic	Wheelchair	$48.00
Oct 5	Valley Clinic to home	Wheelchair	$48.00
Oct 7	Home to Valley Clinic	Wheelchair	$48.00
Oct 7	Valley Clinic to home	Wheelchair	$48.00

The receipt is numbered R-0412 and dated October 7, with Daniel R. (son) as the payer. Total charges are $192.00, the earlier deposit is $50.00, and the amount received with this receipt is $142.00, paid by card ending 4821. The balance still owed is $0.00. Nothing else appears: no diagnosis, no insurance number, no full card number.

Three fields a rider’s tax records depend on

The payment date, the name of the payer, and the amount other payers covered decide whether a receipt works as a tax record.

Payment date. Publication 502 counts a medical expense charged to a credit card in the year the charge is made, whatever day the card bill is paid. It generally does not count payments made this year for care received in a future year, and Publication 969 says a health FSA reimburses expenses incurred during its coverage period and cannot pay ahead for future ones. So a payment for rides not yet taken gets a receipt marked as a deposit with no rides listed, and each ride goes on a receipt once it has been taken. The ride packages guide explains how to sell prepaid rides.
The person who paid. A daughter may pay for her mother’s rides, and a taxpayer can generally count another person’s medical costs only for a spouse, a dependent, or someone who would be a dependent apart from a few income and filing tests (Publication 502). Print the payer and the rider on separate lines and leave the tax question to the rider’s preparer.
Amounts another payer covered. Publication 502 does not allow expenses paid by insurance or other sources, and Publication 969 has the FSA participant state that no other plan paid or reimbursed the cost. A line for covered amounts, even when it reads $0.00, keeps that statement honest.

What stays off a receipt

A receipt names the company, the rides, and the money. Everything else is a risk with no benefit.

Medical detail. The clinic’s name already shows where the ride went. A health FSA asks for a statement that the expense was incurred and its amount (Publication 969), so a diagnosis or the reason for the visit adds nothing.
Identification numbers. No Medicaid ID, insurance member number, or Social Security number. If you file as a sole proprietor under your own Social Security number, print no tax ID at all.
The card number. Print the last four digits. Under 15 U.S.C. 1681c(g), a business that takes credit or debit cards may not print more than the last five digits, or the expiration date, on an electronically printed receipt given to the cardholder at the point of sale. A handwritten receipt or a card imprint falls outside that rule, but the last four digits is still the better habit.

Cash, checks, and corrections

Cash leaves no processor record, so the receipt and its copy are the record. Checks and corrections need the same discipline.

Cash. Use a numbered receipt book with a carbon copy. Hand over the original, keep the copy, and record the payment the same day.
Checks. Write the check number on the receipt and the date it was deposited. If the bank returns it, mark the receipt void in your log and tell the payer in writing that the payment did not clear.
Refunds. Issue a refund receipt with its own number that cites the original, then record the refund where you record the original payment.
Mistakes. Issue a corrected receipt that says which number it replaces. Never edit an old receipt in place.

Keeping your copies

File each receipt with the invoice and the trip record for the rides it paid. Publication 583 lists receipt books, bank deposit slips, invoices, and credit card charge slips among the documents that show the amounts and sources of gross receipts. The IRS page on record keeping gives 3 years after filing as the usual period, and 7 years when a bad debt deduction is claimed. Your record retention schedule should list the longest period any payer contract asks for.

Receipts in HealthRide

In HealthRide, a card payment goes through a pay link or a saved card, and a check or cash payment is recorded on the same ledger. Every payment is matched to its trip, so the date, amount, and method are in one place when a rider asks for a receipt. See payments and invoicing.

Frequently asked questions

Can a card slip or an invoice serve as the receipt?: No. An invoice asks for money before it is paid. A card slip is the processor's record of one charge and names no ride. A receipt is your own record that a payment arrived and which rides it covered. Send one for every payment a private-pay rider or family makes, even when an invoice or a card slip already exists.
What does a rider need on a receipt to claim an HSA or FSA?: A health FSA asks the rider for a written statement from an independent third party that the expense was incurred and its amount, plus the rider's own statement that no other plan paid it (IRS Publication 969). A receipt from your company, which is not the rider, shows the payer, the date, each ride, and the amount, which is what the first statement has to carry. The plan administrator decides what it accepts. A line for anything another payer covered lets the rider sign the second statement truthfully.
Which date goes on the receipt, the ride date or the payment date?: Both, in separate fields. The payment date is the day your company received the money, and the ride date is when the expense was incurred. IRS Publication 502 counts a card charge in the year it is made, but it generally leaves out payments made this year for care received in a future year. Publication 969 says a health FSA reimburses expenses incurred during its coverage period and cannot make advance reimbursements of future or projected expenses. A late-December payment for January rides fits neither rule, so show the rides on the receipt only once they have been taken.
What should stay off a ride receipt?: Leave off the diagnosis, the reason for the visit, any Medicaid or insurance ID number, a Social Security number, and the full card number. Publication 969 asks for a statement that the expense was incurred and its amount, so a diagnosis adds nothing. For a card payment, print no more than the last four digits. Federal law bars more than the last five digits, and the expiration date, on an electronically printed receipt handed over at the point of sale.
Do I give a receipt for a Medicaid ride?: Usually not, because the rider pays nothing for a covered ride. The state plan's payment is payment in full, plus any cost sharing the plan requires of the member (42 CFR 447.15). If the plan requires a copay and you collect it, give a receipt for that amount. The rest of a covered ride is billed to the program or broker.
What if a receipt has an error or the money is returned?: Leave the original alone. For a mistake, issue a corrected receipt with a new number that says it replaces the old one, and note the replacement in your receipt log. For money returned, issue a refund receipt that cites the original number and shows the amount and date. A receipt that vanishes or gets overwritten cannot be explained later.
How long should I keep copies of receipts?: Keep each copy with the invoice and trip record behind it. The IRS lists receipt books, deposit slips, invoices, and credit card charge slips among the documents that support gross receipts, and the usual period for income tax records is 3 years after the return is filed, or 7 years when a bad debt deduction is claimed. A broker or facility contract can require longer.