Medical Transportation Flyer Template for Clinics, Dialysis Centers, and Senior Living

A flyer is often the one piece of paper a discharge planner, a dialysis social worker, or an assisted living front desk keeps about your company. It has one job: let a busy person book the right ride without calling first to ask what you do. This template gives you a content sheet, a one-page layout, panels for each kind of facility, a fax version, and a check against the federal rules that limit what a NEMT flyer can say. For where to take it and who to ask for, see NEMT marketing.

How to use this template

1. Fill in Part 1 before you design anything. Use your business name exactly as it appears on your Medicaid and broker records and your listings. See how to name a NEMT business.
2. List only what you run today. Ride types, towns, and hours you can actually cover next week, not the ones you plan to add.
3. Make one version per audience. Start from Part 2 and swap in the matching panel from Part 3 for dialysis centers, hospitals and clinics, or senior living.
4. Price only private-pay rides, and show the full price. Start from the rate sheet template. Facility accounts get their own terms in the facility transportation agreement.
5. Run the Part 4 check before you print, post, mail, or fax a single copy.
6. Hand it over in person when you can. Fax it only under the Part 5 rules. For email, follow the CAN-SPAM basics in NEMT marketing.
7. Log every copy in Part 6, including fax opt-out requests, which you must honor within 30 days.
8. Reprint when anything changes: hours, service area, prices, phone numbers, or a broker contract you start or end.

The template

Part 1: Content sheet

Item	Your answer	Checked against
Business name, exactly as registered		Medicaid and broker enrollment records
One line on what you do and for whom
Towns or counties you serve, and how far beyond them you go
Ride types you run today: ambulatory, wheelchair, stretcher, bariatric, attendant		Your vehicle list
Hours on weekdays, weekends, holidays, and after hours		Your dispatch schedule
How to book: phone, fax, email, online form
Notice you need: same day, 24 hours, 48 hours
Standing rides offered (dialysis, therapy, chemotherapy)
What riders can expect: door-to-door help, wait time, cancellation rule		Your no-show policy
Who pays: private pay, facility accounts, broker or plan contracts		Signed agreements only
Private-pay price, including every required fee		Your rate sheet
Facility account terms (monthly invoice, who can book)		Your facility agreement
Facility contact: name, direct phone, email
Languages your staff speak
Website or QR code address
Permit or license number, if a rule you follow requires it on ads

Part 2: The flyer (one page)

[Your logo] [Business name as registered]

Rides to medical appointments in ______________ (towns or counties)

We drive ______________ (adults, children with a parent, wheelchair users) to ______________ (dialysis, doctor visits, therapy, hospital discharges).

Ride types: [Walking riders] [Wheelchair, with a ramp or lift] [Stretcher] [Bariatric] [An attendant can ride along]

Hours: ______________ (weekdays) | ______________ (weekends) | ______________ (holidays and after hours)

Book a ride: Call ______________ | Fax ______________ | Email ______________ | Online ______________

Book at least ______ hours ahead. Same-day rides when a vehicle is free. Standing rides for repeat treatments.

What to expect: Help from the door to the vehicle and back. The driver waits up to ______ minutes. Cancel by ______________ to avoid a ______________ charge.

Who pays:

• Private pay: $______________ for a ______________ (the full price, including every required fee)
• Facility accounts: one monthly invoice for rides your staff book
• [Medicaid members of ______________ (plan or program): rides arranged through ______________ (broker), where we hold a contract]

For facilities: ______________ (name), ______________ (direct phone), ______________ (email)

[Business name] | [Street address] | [Phone] | [Website] | [Permit or license number, if required]

Part 3: Panels for each audience

Audience	Headline	Lines to add
Dialysis centers	Standing rides for every chair time	Pickup times for each shift: ______. We call the front desk when a rider is not ready by ______. Late finishes: we wait up to ______ minutes.
Hospitals and clinics	Discharge and same-day rides	Discharge line: ______. Wheelchair and stretcher rides home, or to ______________. Records we need from you: ______________.
Assisted living and nursing homes	Rides to outside appointments	Staff or family can book. Escort into the appointment: ______. One monthly invoice to ______________.
Senior centers and Area Agencies on Aging	Private-pay rides for older adults	Starting price, including every required fee: $______. How families pay: ______________.

Part 4: Before you print

Check	Yes	Rule
No Medicare, Medicaid, CMS, or HHS words, logos, or Medicare card images used in a way that suggests government approval or connection		42 U.S.C. 1320b-10
No line saying Medicare pays for wheelchair, stretcher van, or sedan rides		42 CFR 410.40
A broker, plan, or program is named only where you hold a signed contract		Your agreements
No free rides, gift cards, cash, or discounts offered to Medicaid or Medicare riders, and any giveaway worth $15 or less		42 U.S.C. 1320a-7a(a)(5); OIG, December 7, 2016
If a facility pays for its patients’ rides, this flyer does not advertise them as free or discounted to the public		42 CFR 1001.952(bb)
Every private-pay price includes all mandatory fees		Cal. Civil Code 1770(a)(29) and similar state laws
No price shown for Medicaid rides		42 CFR 447.15
No rider names, photos, or quotes without signed permission		45 CFR 164.508
The fax version has the sender line and the opt-out notice from Part 5		47 CFR 64.1200(a)(4); 47 CFR 68.318(d)

Part 5: Fax version

Sender line (top or bottom margin of each page, or on the first page): Sent ______________ (date) at ______ (time) by ______________ (business name), phone ______________.

Opt-out notice (on the first page, clear and easy to see):

To stop faxes from us: you may ask us not to send any more fax advertisements to your fax machine. Send your request by phone at ______________ or by fax at ______________ [or, if neither number is toll-free, at no cost to you through ______________ (website or email)]. A valid request names each fax number it covers, goes to a number or address in this notice, and stays in effect unless you later give us permission to fax you ads again. You can send a request 24 hours a day, 7 days a week. Under federal law, our failure to honor a valid request within 30 days is unlawful.

Part 6: Distribution log

Facility	Contact	How delivered	Date	Fax only: how you got the number and your relationship	Opt-out asked	Opt-out honored

Medicare and Medicaid names on a flyer

Federal law bars anyone from using the words “Medicare,” “Medicaid,” “Centers for Medicare & Medicaid Services,” “Health and Human Services,” the letters “CMS” or “HHS,” or an emblem of those agencies, including the design of the Medicare card, in an advertisement, circular, pamphlet, or other communication in a way that could reasonably be read as government approval, endorsement, or connection (42 U.S.C. 1320b-10). Lines like “Medicare approved,” “official Medicaid transportation,” or a CMS logo next to your name can read that way. A state agency naming itself is exempt. Your company is not.

Two details make this costly for a flyer:

• A disclaimer does not help. The law says a violation is judged without regard to any disclaimer of government affiliation printed on the item (1320b-10(a)(3)).
• Every mailed or online copy counts. Each piece of mail is a separate violation, and so is each viewing of an electronic copy. The statute sets up to $5,000 per violation, or $25,000 for a broadcast. As of October 2026, the inflation-adjusted maximums in 45 CFR 102.3 are $13,132 and $65,653.

Stating a plain fact is different. “We drive Medicaid members for [broker name]” describes a contract you hold. Keep Medicare off a van company’s flyer, though. Original Medicare covers ambulance transport only when the patient’s condition rules out other transportation (42 CFR 410.40(e)), so it does not pay for a wheelchair van or sedan ride. Some Medicare Advantage plans add rides, and does Medicare cover NEMT explains how those work.

Offers a flyer cannot make

A flyer that reaches Medicaid or Medicare riders cannot offer them a reason to pick you other than your service.

• Free rides and gifts. Offering a Medicare or Medicaid beneficiary anything you know or should know is likely to sway them to get Medicare- or Medicaid-paid services from you can bring a civil money penalty under 42 U.S.C. 1320a-7a(a)(5). “Remuneration” includes items or services given free or below fair market value (1320a-7a(i)(6)). The statute sets up to $20,000 per item or service, plus up to three times the amount claimed and possible exclusion. As of October 2026, 45 CFR 102.3 lists the adjusted maximum as $25,595.
• Small giveaways. OIG’s policy statement of December 7, 2016 treats gifts worth $15 or less per item and $75 or less per person per year as nominal, and never cash or cash equivalents. A pen or a magnet with your phone number fits. A “first ride free” coupon does not.
• New York. The state’s Medicaid transportation policy manual (effective August 25, 2023) says it is illegal for a transportation provider to pay or even offer to pay a Medicaid enrollee for using its services, and “pay” includes free or discounted personal transportation. Medical Answering Services, the state’s Medicaid transportation broker, says in its network manual (Version 2023-1, October 1, 2023) that any exchange, gift, or favor between an enrollee and a provider, its driver, or its staff is possible fraud and will be reported to the state health department and the Office of the Medicaid Inspector General.

Facility-paid rides carry one more limit. When a dialysis center or clinic pays for its own patients’ rides under the local transportation safe harbor, it may not publicly market or advertise the free or discounted rides, and no one may market health care items or services during the ride (42 CFR 1001.952(bb)). OIG explained in its December 7, 2016 rule (81 FR 88387) that telling a patient directly, such as when booking a follow-up visit, that a ride is available is not marketing, but advertising it on websites or in printed materials handed to the public is. So for those programs, give the flyer to the staff who arrange rides, leave “free” off it, and keep it off public bulletin boards.

Gifts and meals for the staff who refer riders are a separate question, covered in anti-kickback rules for NEMT.

Faxing a flyer to a clinic

Many clinics and dialysis centers still book rides by fax. A faxed flyer is an “unsolicited advertisement” unless the office gave prior express invitation or permission, in writing or otherwise (47 CFR 64.1200(f)(16)). Without that permission, you may fax it only when all three of these are true (47 CFR 64.1200(a)(4)):

1. You have an established business relationship. That means a prior or existing relationship formed by a voluntary two-way exchange, such as an inquiry, an application, or rides you have run for the office, that neither side has ended (64.1200(f)(6)).
2. You got the number the right way. The office gave it to you within that relationship, or published it in its own directory, advertisement, or website without saying it refuses fax ads. From any other source, you must take reasonable steps to confirm the office agreed to share it.
3. The fax carries a complete opt-out notice. It must be clear and conspicuous on the first page, say the office may ask you to stop and that failing to honor a valid request within 30 days is unlawful, explain what a valid request needs, and give a domestic phone number and a fax number that work 24 hours a day, 7 days a week. If neither number is toll-free, add a free way to ask, such as a website or email address. Part 5 holds that notice.

Honor each request in the shortest reasonable time, never more than 30 days. An opt-out also ends the business relationship exemption for future fax ads to that office. If a fax service sends for you, you are still liable for opt-outs it fails to honor (64.1200(a)(4)(v)). Separately, every fax must show the date and time sent, your business name, and your phone number at the top or bottom of each page or on the first page (47 CFR 68.318(d)).

Mistakes are expensive. When a fax ad misses the three conditions above, the person or office that gets it can sue for its actual loss or $500 per violation, whichever is greater, and a court can triple that for a willful or knowing violation (47 U.S.C. 227(b)(3)).

Broker rules on reaching riders

Broker work comes through the broker, not through flyers in riders’ hands. Modivcare’s provider manual for Mississippi (February 2024) says Modivcare does not let members pick their transportation provider, though members and medical providers do influence its assignments by reporting good and bad service. Your flyer helps when it reaches the clinic staff who report on your service, which is why dialysis transportation and facility contracts start with those relationships.

Brokers also limit what drivers do on a trip. As of October 2026:

• MTM Health in Rhode Island. Its provider handbook (last updated July 1, 2026) says drivers may not solicit or accept money, goods, or additional business from members, may not try to influence members, their families, attendants, escorts, or medical providers to get additional business, and may not contact a member for any purpose beyond completing the assigned trip. It also bars drivers from giving members food or drinks.
• MTM Health in Pennsylvania. The January 1, 2023 provider agreement that Pennsylvania’s Department of Human Services posts says member information is held in the strictest confidence and used only to perform the agreement (section 21.F). Trip manifests are never a mailing list for flyers.
• Medical Answering Services in New York. Its network manual (October 1, 2023) treats any gift or favor between an enrollee and a provider’s driver or staff as possible fraud.

Read the manual for each broker you drive for, then put the rule in your driver handbook: flyers go to facility staff, never to riders in the vehicle.

Prices on the flyer

Private riders and families compare prices, so print one they can trust. In California, advertising or displaying a price that leaves out any mandatory fee, other than government taxes, is a prohibited practice (Civil Code 1770(a)(29), amended effective January 1, 2026). The Attorney General says the rule has applied since July 1, 2024, covers goods and services bought for personal use, and does not cover purchases for commercial use. A fuel or wait-time charge every rider pays belongs inside the price on a flyer for families. Other states have added similar rules, listed in NEMT fuel surcharges.

Never print a price for Medicaid rides. A Medicaid provider must accept the program’s payment, plus any copay the state plan sets, as payment in full (42 CFR 447.15). Private pay NEMT covers when a Medicaid member may pay privately and how to price those rides.