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Template · Free download

NEMT Daily Trip Log Template

A ready-to-use spreadsheet for non-emergency medical transportation trips — the columns brokers, facilities, and Medicaid auditors actually ask for. Opens in Excel or Google Sheets.

What's inside

Trip #Member NameMember IDPickup AddressScheduled PickupActual PickupDrop-off AddressActual Drop-offTrip TypeMobility AidOdometer Start / EndMilesWait TimeNo-Show / CancelNotesSignature

20 pre-numbered trip rows plus a trip-type/mobility-aid legend at the bottom.

Free download — where should we send it?

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Using it well

  • Log every trip the same day — brokers and Medicaid MCOs audit trip records, and reconstructed logs get rejected.
  • Record actual pickup and drop-off times, not just scheduled ones. On-time performance is how brokers score providers.
  • Capture the member or facility signature on delivery — it's your proof the trip happened if a claim is disputed.
  • Mark no-shows and cancellations explicitly; most brokers still pay a no-show fee if it's documented.

This log fills itself in PRIME

Trips, timestamps, mileage, and signatures captured automatically by the driver app — export-ready for broker audits.

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