NEMT Rider Profile Form: One Record of How Each Regular Rider Travels

Regular riders get asked the same questions again and again: which door, how many steps, what chair, who to call. A rider profile answers them once. It saves the office time on every booking, and it keeps a new driver from showing up with the wrong vehicle for a rider your company has carried for a year. It also sets a limit: the profile records how the rider travels, not their medical history.

How to use this template

1. Make a profile for each rider you carry again and again: standing-order riders, private pay regulars, and facility residents. Each ride still needs its own trip request form or broker trip. The profile fills in what stays the same.
2. Fill it in with the rider or the person who handles their rides, by phone or at the first pickup. Read the questions aloud when the rider cannot fill them in, and let the rider skip any question.
3. Ask how, never why. Part 4 asks what the rider uses and what they can do, such as standing to pivot into a seat. It never asks for a diagnosis. What to leave off the profile has examples.
4. Check every broker trip against it. For a Medicaid rider, the broker’s trip sets the vehicle and level of help. When the profile and the trip disagree, call the broker before the ride. NEMT trip intake covers the booking call around it.
5. Copy only Part 9 onto the manifest. Part 9 gathers what a driver needs for this rider. Put those notes on the daily manifest and leave the rest of the profile in the office.
6. Review it on a schedule. Ask again at every standing order renewal, after any hospital stay, and whenever a driver reports a change. Log each change in Part 10.
7. Store it where only booking and dispatch staff can open it: a locked file for paper, or a system that needs each person’s own login.

The template

Fill in one profile per rider. Write “Skip” for any question the rider does not want to answer.

Part 1: Rider and how to reach them

Field	Entry
Rider’s full name, and the name they like to be called
Date of birth (only to tell apart riders with the same name)
Home address, with apartment or unit number
Main phone, and a second phone
Best way to reach: call / text / a helper named in Part 2
Voicemail: OK to leave the pickup time? Yes / No
Any phone number or address we should not use to reach the rider
Language the rider prefers, and whether an interpreter helps
Hearing, speech, or vision: relay calls (711), speak slowly, large print, other
Emergency contact: name, relationship, phone

Part 2: People who help with rides

Name and relationship	Phone	May book or cancel rides	May be told pickup times	Legal authority: guardian, health care agent, or none

Part 3: Who pays for the rides

Field	Entry
Medicaid broker or health plan, if rides are booked through one
Private pay: who is billed, and how
Facility that pays, with its billing contact

Part 4: How the rider moves

Question	Answer
Walks without help / cane / walker / manual wheelchair / power wheelchair / scooter / stretcher
Can stand and pivot into a vehicle seat without being lifted? Yes / No
Stays in the wheelchair for the ride? Yes / No
Wheelchair or scooter make and model, if the rider knows it
Width and length of the chair, if larger than a standard chair
Weight of the rider together with the chair or scooter
Marked tie-down points on the chair, such as a WC19 label? Yes / No / Not sure
Lap tray, leg rests, or headrest that add to the chair’s size
Walker, cane, or folding chair to store during the ride
How the rider likes help getting in and out

A chair labeled WC19 is built with crash-tested tie-down points. See WC19 wheelchair.

Part 5: Level of help

Question	Answer
Curb to curb / door to door / door through door / hand to hand
Can the rider be left alone at the destination? Yes / No
Who receives the rider at home when they cannot be left alone (name, phone)
Who helps the rider on steps or with transfers, if anyone
Extra time needed to board or to reach the door

The help levels are explained in level of service and hand-to-hand service.

Part 6: Pickup at home

Question	Answer
Door to use, and where the van can stop
Steps between the door and the van (how many), with any railing, ramp, or elevator
Gate code, buzzer, lobby, or front desk
Pets to put away before the driver comes to the door
Poor lighting, ice, or other hazards at night or in winter
Where the rider waits when ready early

Part 7: Who and what rides along

Item	Details
Oxygen: portable tank or concentrator, brought and managed by the rider
Service animal
Escort, caregiver, or attendant who usually rides
Children who ride along, and who brings each car seat or booster
Bags, medical supplies, or other items

Part 8: Comfort and preferences

Question	Answer
Seat the rider prefers, when there is a choice
Heat, cold, or motion that bothers the rider
A driver the rider knows (we try to keep the same driver, but cannot promise)
What helps when the rider is anxious or confused: a call ahead, the same driver, a quiet ride
Anything else the rider wants drivers to know

Part 9: Driver notes (copy to the manifest)

Note	Entry
Door, steps, and where to stop
Mobility aid and help needed
Who meets the rider at home or at the destination
Items and people riding along
One line the rider wants the driver to know

Part 10: Review log

Date	What changed	Heard from (rider, family, driver, facility)	Broker told on	Staff initials

What to leave off the profile

The profile asks for what a driver has to do and bring, not the reason behind it. That gives the driver better instructions and puts less health information at risk.

Write this	Not this
Power wheelchair, stays in the chair, 380 pounds with the chair	The illness that put the rider in the chair
Brings and manages their own portable oxygen	The lung condition behind it
Hand to hand, never leave alone, daughter meets at home	A dementia diagnosis
Needs extra time and a steady arm on two front steps	Details of a recent surgery
Rides to the same clinic three days a week	What the treatment is
Nothing	Social Security number, medication list, or copies of medical records

If your company is a HIPAA covered entity or business associate, this is the law, not only good practice. HIPAA for NEMT providers explains when it applies, and minimum necessary defines the rule.

• Limit what you use and ask for. You must make reasonable efforts to limit health information to the minimum needed for the purpose (45 CFR 164.502(b)). The rule does not limit what you share with the rider, so a rider may see their own profile.
• Use a standard form for routine requests. When you request health information from another covered entity on a routine basis, such as asking a nursing home to fill in this profile for a resident, your policies (a standard form is enough) must limit the request to what is reasonably necessary. You may not ask for a whole medical record unless that is specifically justified (45 CFR 164.514(d)).

Broker contracts ask for the same care. CareOregon’s manual (February 2024) has providers treat every part of a trip as confidential, including the fact that a member is on the program and anything about their physical or mental health. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, requires providers to keep member health and personal information confidential and to sign its business associate agreement. It also bars providers, drivers, and attendants from asking about a member’s illness or the medical services they receive, unless the answer is needed to arrange the right transportation or the member becomes ill during the trip.

Who sees which part

HHS guidance on the minimum necessary rule says your policies must identify the staff, or groups of staff, who need health information, the kinds they need, and any conditions on their access. Case-by-case review of each use is not required (content last reviewed July 26, 2013). A profile split into parts makes that easy to set up.

Role	Parts	What they use it for
Booking and scheduling staff	All parts	Matching each booking to the rider’s needs
Dispatchers	Parts 1, 2, and 4 to 9	Picking the vehicle and briefing the driver
Drivers	Part 9, for their own legs only	The door, the help, and who meets the rider
Billing staff	Parts 1 and 3	Billing the right payer

Covered entities must make reasonable efforts to limit each role’s access to the information it needs (45 CFR 164.514(d)(2)). They must also reasonably safeguard health information and limit incidental disclosures (45 CFR 164.530(c)). For a profile, that means a locked drawer or a login, and never a copy left in a van.

How the profile works with broker trips

On a Medicaid trip, the broker decides the mode and level of help. Your profile tells you when that decision may be out of date.

• Follow the authorization. MTM Health’s Virginia handbook (approved August 10, 2026), for fee-for-service trips from October 1, 2026, says providers and drivers must not alter the assigned mode without approval. Using an unapproved mode, swapping vehicles, or giving a level of assistance that does not match the authorization can mean no payment or corrective action. Its manifests list the member’s weight, including mobility devices or medical equipment.
• Send changes to the broker. The same handbook has members tell MTM about special transportation needs when they schedule, including an extra passenger. CareOregon requires approval for a different vehicle type unless the vehicle sent still meets the rider’s needs. When a driver reports a new power chair or a rider who can no longer walk to the van, call the broker and log it in Part 10.
• Know how the state sorts riders. MO HealthNet’s manual (posted April 2026) counts a manual wheelchair user who can stand or pivot on their own as ambulatory. A rider who uses an electric wheelchair, or a manual chair and cannot transfer, is wheelchair level, and a bed-confined rider needs the broker’s Stretcher Assessment Form. That is why Part 4 asks about standing and pivoting.
• Service changes are the broker’s call. CareOregon’s manual says providers do not modify a member’s service. The brokerage may, for example by requiring an attendant, a certain provider, or a confirmation on the day of the ride, and providers help carry that out.
• The profile gives you no claim on the rider. MTM Health’s standard agreement says trips, including recurring trips, may be assigned or reassigned at MTM’s discretion, and a provider has no right to transport any particular person.

The profile also tells dispatch what a driver cannot do, before the van arrives. MTM Health’s Virginia provider page (September 2026) says drivers may not carry a member or a wheelchair up or down steps, and may not help with personal care, medication, or oxygen unless on an ambulance. A hand-to-hand rider stays in the driver’s sight until handed to a person at the facility or home. CareOregon’s manual has drivers guide members on stairs when needed, but they may not physically assist or carry a member up or down them. It also puts transfers into or out of a wheelchair or bed, and full-weight support while walking, outside the driver’s job unless the driver is licensed, trained, and authorized by the brokerage. Parts 5 and 6 ask about steps and transfers for this reason.

Rules the form follows

Family, representatives, and callers

If HIPAA applies to you, these rules shape Parts 1 and 2:

• People involved in care. You may share information directly relevant to a family member’s, friend’s, or other named person’s involvement in the rider’s care, when the rider agrees, has the chance to object and does not, or you reasonably infer no objection (45 CFR 164.510(b)).
• Legal representatives. A person with legal authority to make the rider’s health care decisions, such as a guardian, is treated as the rider for information relevant to that authority (45 CFR 164.502(g)).
• Callers you do not know. For other callers, verify their identity and authority before you share anything (45 CFR 164.514(h)). CareOregon limits disclosure to the member, the member’s caregiver or representative, and the member’s health care provider.
• Other ways to reach the rider. A covered health care provider must accommodate reasonable requests to receive communications by another means or at another place, and may not require the rider to explain why (45 CFR 164.522(b)). The voicemail and “do not use” lines in Part 1 record those requests.

Rider rights under the ADA

Federal ADA transportation rules in 49 CFR Part 37 apply to public and private companies, and they set limits on what the profile can be used for:

• Attendants. You may not require a rider with a disability to bring an attendant (49 CFR 37.5(e)). Part 7 asks who usually rides so a seat is saved, not as a condition. You also may not add special charges for services needed to accommodate a rider with a disability (37.5(d)).
• Size and weight. Lifts on ADA vehicles have a design load of at least 600 pounds, and the platform has at least 30 inches of clear width and 48 inches of clear length, measured from 2 to 30 inches above the platform surface (49 CFR 38.23). You must carry a larger or heavier rider and chair when your lift and vehicle can handle them, and may decline when the combined weight exceeds the lift’s specifications (49 CFR 37.165(b)). See bariatric transportation.
• Securement and transfers. You may not refuse a ride because the chair cannot be secured well, and you may suggest a move to a vehicle seat but not require it (37.165(d) and (e)).
• Service animals and oxygen. You must let service animals ride, and may not bar a respirator or portable oxygen, within federal hazardous materials rules (49 CFR 37.167). Private companies that carry people also follow the Justice Department’s rule: ask only whether the animal is required because of a disability and what task it is trained to do, and never require papers (28 CFR 36.302(c)(6)). See service animals in NEMT and riders with oxygen.
• Ways to communicate. You must give riders with disabilities adequate information and ways to reach you, through accessible formats and technology, so they can learn about the service and schedule it (37.167(f)).

Language

MTM Health’s standard agreement says it is in the provider’s best interest to have drivers or office staff fluent in the languages common in its service area. Section 1557 of the Affordable Care Act reaches health programs that receive federal financial assistance from HHS, directly or indirectly (45 CFR 92.2). Where it applies, language help must be free, and you may not require a rider to bring their own interpreter. You also may not rely on a child to interpret except as a temporary measure in an emergency (45 CFR 92.201). Recording the rider’s language in Part 1 lets the office line up help before the call. For more, see limited English proficiency.

Children and escorts

The rules for children differ by program, which is why Part 7 asks who rides along and who brings each car seat.

Program	Children who must ride with an adult	Car seats
Texas Medicaid health plans (UMCM 16.4)	14 and under, with a parent, guardian, legal representative, or an adult they authorize in writing. Ages 15 to 17 too, unless signed consent is presented in advance or the care is confidential for minors	If the child has no seat at pickup, or the parent cannot install it, the trip is canceled as a member no-show. Drivers do not install seats
New York, MAS (October 1, 2023)	Under 18, with a responsible parent or guardian	Vehicles must be able to secure a seat the family provides (state manual, August 25, 2023)
CareOregon (February 2024)	12 and under, with an attendant	Drivers do not provide or install seats, and may not carry a child who needs one without it

MTM Health’s Virginia handbook (approved August 10, 2026) has parents or guardians provide safety seats for children through age seven, sized for the child’s age and weight. MTM Health’s standard agreement has providers carry the member and one escort or attendant as requested, and more than one needs MTM’s approval. Texas also says a 15 to 17 year old’s consent must be verified at the time of the trip if the provider does not have it on hand, so note in Part 2 when the plan has it on file. See children in NEMT and escorts and caregivers.

Keeping old versions

A profile that shaped how trips were run belongs with your records. When something changes, date the new version and keep the old one. MTM Health’s standard agreement requires full and complete records of your operations under it for 10 years, or longer where the law or its clients require. MO HealthNet’s manual gives each participant the right to request and receive a copy of their transportation records. NEMT record retention lists the other periods that may apply.