LogistiCare Daily Trip Log free printable template
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Mail Invoices to LogistiCare Billing Dept. 503 Oak Place Ste 503 Atlanta GA 30349 DAILY TRIP LOG Job A or B Recipient s Name A W S Per Trip Billed Amount Date of Service Total Trip Mileage Vehicle Number Last six of the VIN Will-Call Time DRIVER S NAME as it appears on driver s license Drop-off WEEK ENDING Pick-up KI BOIS Area Transit System - 9 Provider Name Recipient s Signature NOTE Leg of transport - a leg of transport is the point of pick-up to the destination. Example Picking recipient...
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How to fill out daily trip log form
How to fill out LogistiCare Daily Trip Log
01
Gather all necessary trip information before starting the log.
02
Fill in the date clearly at the top of the log.
03
List the driver's name and ID number in the designated fields.
04
Enter the names of the passengers for each trip.
05
Record the pickup and drop-off addresses for each trip.
06
Note the scheduled time for each pickup and drop-off.
07
Indicate the actual time of pickup and drop-off.
08
Include any additional information such as special instructions or notes.
09
Double-check all entries for accuracy.
10
Sign and date the log after completing all trips for the day.
Who needs LogistiCare Daily Trip Log?
01
Transportation providers contracted by LogistiCare.
02
Drivers who are involved in providing transport for eligible passengers.
03
Agencies requiring documentation of transportation services provided.
04
Individuals or organizations managing non-emergency medical transportation.
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What is LogistiCare Daily Trip Log?
LogistiCare Daily Trip Log is a document used to record transportation details for non-emergency medical trips provided to patients.
Who is required to file LogistiCare Daily Trip Log?
Transportation providers, including drivers and companies contracted by LogistiCare, are required to file the Daily Trip Log.
How to fill out LogistiCare Daily Trip Log?
To fill out the LogistiCare Daily Trip Log, the driver must enter details such as the date, times, patient's name, address, pickup and drop-off locations, and any specific comments regarding the trip.
What is the purpose of LogistiCare Daily Trip Log?
The purpose of the LogistiCare Daily Trip Log is to maintain accurate records of patient transportation, ensure accountability, and facilitate payment for services rendered.
What information must be reported on LogistiCare Daily Trip Log?
The information that must be reported includes the date of service, patient identification, pickup and drop-off addresses, times of transport, vehicle identification, and any relevant notes about the trip.
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