Non-Emergency Medical Transportation Expense Log - MN 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Driver’s Name and Client Name at the top of the form. Ensure accuracy as this information is crucial for processing.
3. Fill in the addresses, including both your address and the pick-up address, along with city and zip codes. This helps in verifying transportation details.
4. Input the Vehicle License Number, Driver's License Number, and Client’s Date of Birth. These fields are essential for identification purposes.
5. For each date of service, specify the appointment date and time, along with the name and location of the medical facility. Indicate if lodging is required by selecting 'Yes' or 'No'.
6. Document total mileage traveled for reimbursement. Attach itemized receipts for meals and parking where applicable.
7. Ensure that both the provider's signature and your signature are included at the bottom of the form to validate your claims.

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