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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 re....

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To show proof of mileage for reimbursement, maintain a detailed LogistiCare Daily Trip Log that records every trip accurately. Include the date, start and end points, purpose of the trip, and total miles driven. You can also attach receipts for any related expenses, such as fuel or tolls, to reinforce your claim. Providing robust documentation will help ensure you receive the reimbursement you deserve without delays.

Calculating standard mileage reimbursement example Later, she drives 11 miles to meet a client and 11 miles to drive back to the office. Caitlin drove 36 business miles. So, you reimburse her $24.12, because the standard mileage rate is 67 cents. (0.67 standard mileage rate x 36 business miles driven).

Below is a simple reimbursement calculation using this rate: reimbursement amount = miles * rate. $134.00 = 200 miles * $0.67.

For example, if you drove 1200 business miles in 2023 with your personal vehicle, and the IRS mileage rate for the same year is 65.5 cents per mile, your calculation will look as follows: [miles] * [rate], or 1200 miles * $0.655 = $786 you can claim as a deduction on your tax return.

Here's how it works Write the date of the scheduled trip on the form. ... Fill out the entire form. ... Take the form with you to your appointment. ... Please note that there can only be one driver on a form. ... Once your form is complete, follow the instructions on the form to submit.

0:52 2:26 How to Fill out the Medical Mileage Form in Workers Comp - YouTube YouTube Start of suggested clip End of suggested clip Box by 0.575 don't forget to add any parking payments or tolls. Once you have reached a total ofMoreBox by 0.575 don't forget to add any parking payments or tolls. Once you have reached a total of over 25. Dollars you can then submit your form copy your completed. Form.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232