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Get LogistiCare Daily Trip Log

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 up at residence and transporting to the doctor s office would be considered one leg picking the recipient up at the doctor s office and transporting back to the residence would be considered the second leg of the trip. Each leg of transport must be documented on separate lines. A signature is required for each leg of the transport. Pick-up and drop-off times must be documented and in military time. Driver s Comments I understand that LogistiCare Inc* will verify the accuracy of the mileage being reported and I hereby certify the information herein is true correct and accurate. A signature is required for each leg of the transport. Pick-up and drop-off times must be documented and in military time. Driver s Comments I understand that LogistiCare Inc* will verify the accuracy of the mileage being reported and I hereby certify the information herein is true correct and accurate. .

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