Instructions: Drop down the Trip Number to view your Trips for today Select a Trip Number to see details Fill all the empty spaces and hit “Submit” to log in your trips. Manifest - Wilda Trip Number: * Trip Date: Member Information Member Name: Appointment: Member Phone: DOB: A2C ML Special Needs: Section Buttons Trip Information Pickup Location: Pickup Location 2: Pickup County: Pharmacy Auth: Drop Off Location: Drop Off Location 2: Drop Off Phone: Section Buttons Comments: Scheduled Pickup Time: * This time must always be earlier than Appointment. If not, it means you are late and you must enter a reason in the notes. Arrived Time: * Select 12:00AM for Trip Cancellations or No Show Pickup Time: * Select 12:00AM for Trip Cancellations or No Show Drop Off Time: * Select 12:00AM for Trip Cancellations or No Show RETURN TRIP Notify Time: ONLY FOR RETURN TRIPS: The time the Member calls back for their Return Trip Pickup Odometer * Drop Off Odometer * Mileage Section Buttons Provider Information Provider: Driver Name: * Driver's License: Vehicle Name: Vehicle Vin: Section Buttons Trip Status: * Completed Cancellation No Show Left Card OtherOther Driver's Signature: * Section Buttons Attendant Name Attendant's Signature / Picture of Door (No Show): * If member cancels, upload driver signature here as well Cancelation / No show / Lateness Notes (If applicable): If you are human, leave this field blank. Submit Δ Sign GPS Back
umsdigital Post author December 11, 2021 at 3:42 pm Reply Hello Wilda, Kindly note that you have to fill in the details of the trips and upload the signatures of the member as well as your signature
Done
Hello Wilda,
Kindly note that you have to fill in the details of the trips and upload the signatures of the member as well as your signature
Stop was canceled
Canceled
Canceled