Non-Emergency Medical Transportation Log
Form Template
As part of the Medicaid program and some health care plans, patients can be eligible for non-emergency medical transportation services.
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When a physician deems it a medical necessity and obtains prior authorization, eligible patients can receive transportation services to medical appointments. It is important to log this information and keep track of all patient transportation and non-emergency medical transportation services. Health care providers and transportation providers can use the Non-Emergency Medical Transportation Log app to keep this information on file. The app records: company name, name and Medicaid number, address, destination, departure time, arrival time, driver's name, and offers a space for additional comments.
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