Florida Facility Network

FloridaFacility Network

Downloads

Please click on the title that corresponds to the document you would like to view, and then click on print or download as necessary.

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

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