Florida Facility Network

FloridaFacility Network

Downloads

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 TitleDescription
Bus Pass Log FormThis is the form used for the Bus Pass Program.
Standing Order Change FormThis is used by facilities to change an existing Standing Order.
Single Trip Request FormCan be used for scheduling a one time trip.
Physician Transportation Restriction FormIs used to authorize a higher level of transportation or change the level of transportation.
MNF Level of NeedVerification of medical transportation abilities
Mileage Reimbursement Trip LogThis is the log sheet for recording scheduled appointments. When completed this sheet is submitted for reimbursement.
Mileage Reimbursement ProgramMany health care plans offer Mileage Reimbursement. This outlines the Mileage Reimbursement Program.
Standing Order FormIs used by facilities to schedule trips for members that travel three or more times a week.
Member and Facility Website DirectionsTransportation reservations can be arranged by facilities and members. This outlines the program.
Hurricane - Holiday Schedule Change FormThis form is used by facilities to make one time changes to Standing Order due to Hurricane or Holidays.
Generic Transportation GuidelinesThis contains a basic outline of the transportation program, guidelines and expectations.
Florida Toll Free Reservations & Ride Assist Phone NumbersThis contains the contact information for the programs LogistiCare services.
Community Care Plan DirectionsDocuments and instructions for Community Care Plan members
Child Consent FormFL Child Consent Form
Bus Pass ProgramThis outlines the Bus Pass Program.
Medical Facility EDI Administrator User FormThis form is used by the facility to reregister on the Logisticare Facility Website.
Sunshine Health TripCare Registration Letter 

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