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["NATURAL ENVIRONMENT TRAVEL LOG INSTRUCTIONS"]
[]
["This form serves two primary purposes:"]
["● Statewide uniform documentation of travel paid to providers with contract funds."]
["● Statewide uniform billing documentation for provider travel."]
[]
["Every provider who will be paid for mileage when traveling must complete a line on this form for travel to the child’s natural environment for a service, or to a Consultation session destination.  Each provider must have their own form. Travel is reimbursable for a provider to travel from their official place of business to the first destination for service delivery, and each subsequent destination for service delivery, and back to the provider’s official place of business. "]
[]
["Easterseals Florida will reimburse the shortest mileage for each trip, regardless of the actual route taken. Please look up each trip in MapQuest to determine the shortest mileage. "]
[]
["Provider Name = The name of the provider traveling to reimbursable destinations.  Each individual provider must record travel on their own form."]
[]
["Date = Day of travel.  One form can be used for multiple days of travel."]
[]
["Point of origin, Address = When you get in your vehicle enter the address where travel begins.  This cannot be your home address, unless that is your official place of business.  "]
[]
["Destination, Child’s Name & Address = Enter the child’s name who will be receiving service, or who will be discussed at a Consultation session or IFSP meeting.  Enter the address where service delivery, Consultation or IFSP meeting will take place, or at the end of the day, the address of your official place of business.  This cannot be your home address, unless that is your official place of business. "]
[]
["Parent signature (Required): The highlighted area under the mileage section is used for the family’s signature. If the travel is for a Consultation session the family can also sign, or if they are not face to face with the team, the service coordinator or other team member can sign as verification.  "]
[]
["When the log is full or your invoicing period is over, the provider must sign at the top right of the form to attest to the accuracy of the information.  This form must accompany the invoice billing the travel to Easterseals Florida"]

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[]
[]
[null,null,null,null,null,null,"Natural Environment Travel Log"]
[]
[]
["Provider Name",null,null,null,null,null,null,null,null,null,"Provider Signature"]
[null,null,null,null,null,null,null,null,null,null,"I attest that the following information is true and accurate."]
[]
["Please note: Easterseals Florida will reimburse the shortest mileage for each trip, regardless of the actual route taken. Please look up each trip in MapQuest to determine the shortest mileage. "]
[]
["Date","Point of Origin",null,null,null,null,"Destination",null,null,null,null,"Miles","Charge $"]
[null,"Address",null,null,null,null,"Child's Name & Address",null,null,null,null,"Traveled"]
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[]
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[]
[null,null,null,null,null,null,null,null,null,null,"Total = ",{"$f":"SUM(L13:L77)","v":0},{"$f":"SUM(M13:M77)","v":0}]