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EMERGENCY MEDICAL TRANSPORTATION TRIP TICKET NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES MEDICAL SERVICES DIVISIONClear Fieldsman 296 (12019)The driver must record the information for each leg of a
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How to fill out non-emergency medical transportation trip

01
Start by gathering all the necessary information, such as the date and time of the trip, the pickup and drop-off locations, and any special requirements or medical equipment needed during the trip.
02
Contact the non-emergency medical transportation provider to schedule the trip. Provide them with the information you gathered and ask if there are any specific forms or documents that need to be filled out.
03
Fill out any required forms or documents, providing accurate and detailed information. Make sure to include your personal information, medical condition, and any specific instructions for the transportation provider.
04
If there are any insurance or payment arrangements that need to be made, provide the necessary details to the transportation provider. This may involve submitting insurance information or arranging for payment directly.
05
Double-check all the information you have provided before submitting the forms or documents. Ensure that everything is accurate and complete.
06
Submit the filled-out forms or documents to the non-emergency medical transportation provider as instructed. Follow any additional instructions they may provide regarding confirmation or verification of the trip.
07
On the day of the trip, be prepared and ready for the scheduled pickup time. Make sure you have any necessary documents, medications, or medical equipment with you.
08
During the trip, follow any instructions or guidelines provided by the transportation provider. If you have any concerns or issues during the trip, communicate them promptly to the driver or contact the transportation provider's customer service.
09
Upon arrival at the destination, ensure that you have all your belongings and any necessary medical equipment before exiting the vehicle.
10
Finally, provide feedback to the non-emergency medical transportation provider about your experience. This can help them improve their services and ensure a better experience for future passengers.

Who needs non-emergency medical transportation trip?

01
Anyone who requires non-emergency medical care or assistance and is unable to use conventional means of transportation may need non-emergency medical transportation. This can include individuals with mobility limitations, patients undergoing medical treatments, senior citizens with medical appointments, or anyone with a medical condition that prevents them from driving or using public transportation.
02
Non-emergency medical transportation services are also often used by hospitals, nursing homes, and other healthcare facilities to transport patients between facilities or to attend medical appointments.
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Non-emergency medical transportation trip is transportation services provided to individuals who require assistance getting to their medical appointments but do not require immediate medical attention.
Healthcare providers, transportation companies, or individuals providing non-emergency medical transportation services are required to file non-emergency medical transportation trip.
Non-emergency medical transportation trip can be filled out by providing details such as patient information, date of transport, type of transportation used, and reason for transportation.
The purpose of non-emergency medical transportation trip is to ensure that individuals who require assistance getting to their medical appointments are able to do so in a safe and timely manner.
Information such as patient name, date of birth, pickup and drop-off address, date and time of transport, type of transportation used, and reason for transportation must be reported on non-emergency medical transportation trip.
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