The Aging Services Transportation Program is…

A program that provides transportation to non-emergency medical appointments, pharmacies, grocery stores, food banks, and other basic errands. Rides are provided by volunteers using their personal vehicles, and a staff driver. Restaurants or other ineligible locations, even if they are on the way to or from another location, are NOT permissible.

To be eligible for the Transportation Program…

• Individuals must be age 60+
• Be able to walk independently and get in/out of the volunteer’s vehicle with little or no assistance.
• Participants who use a cane or walker are eligible if they meet the above requirements.
• Wheelchairs cannot be accommodated at this time.

Interested individuals may fill out the application and will be contacted by the Transportation Coordinator.

Aging Services and its programs will consider this application without regard to race, color, creed, religion, national origin, gender, sexual orientation, disability, age, marital status, public assistance status, genetic or family medical history, or any other protected classification under local, state or federal law.

Prohibition on Re-disclosure

This form does not authorize re-disclosure of medical information beyond the limits of this consent. Where information has been disclosed from records protected by federal law for alcohol/drug abuse records or by state law for mental health records, federal requirements (41 D.F.R. Part 2) and state requirements (Iowa Code ch. 228) prohibit further disclosure without the spe‐ cific written consent of the patient, or as otherwise permitted by such law and/or regulation. A general authorization for the release of medical or other information is not sufficient for these purposes. Civil and/or criminal penalties may attach for unauthorized disclosure of alcohol/drug abuse or mental health information.

Policies for the Transportation Program include…

• Transportation is available Monday through Friday between 8:30am and 4:00pm. This allows the drivers to have all clients returned home prior to the end of the Aging Services business day. Please plan accordingly when scheduling appointments.
• Rides must be requested a minimum of seven (7) days prior to the appointment to provide the Coordinator sufficient time to arrange a driver. (e.g. a Tuesday appointment must be requested no later than the previous Tuesday)
• All stops must be scheduled and approved in advance by the transportation coordinator. Any additional stops must be requested when making the initial ride request. Additional stops cannot be accommodated the day of the ride.
• Riders utilizing a walker must remove any attached personal belongings including walker bags from their walker. This is to ensure the safety of the driver when loading and unloading the walker in their vehicle.
• Rides should be cancelled at least 24 hours in advance to ensure we have time to notify the driver. Repeated short-notice cancellations or other recurring communication issues may result in being discharged from the program.
• Drivers may wait in the waiting room or car, or may leave while a client’s appointment is in progress. Participants should discuss the plan with their driver that day.
• Drivers may, at their own discretion, provide limited assistance at stores, and may help participants carry groceries into the home. In consideration of our volunteers’ time, we are unable to provide rides to superstores such as Walmart and Target.
• Medical appointments that require frequent and regular repeat visits (e.g. dialysis, ongoing therapy, and/or infusions) cannot be accommodated at this time.
• If there is an additional rider attending an appointment with a participant, the additional rider must also qualify for the transportation program and be a client themselves.
• The Aging Services Transportation Program is unable to provide rides home from any procedure requiring anesthesia or for any participant who needs a second party to sign them out from a location. This is for the safety of the participant and the volunteer.

IMPORTANT NOTE… The Transportation Program depends on volunteers and funding from various sources. Clients repeatedly violating policy, asking a volunteer to disregard policy, or who choose to mistreat a volunteer or staff member in any way, will be immediately and permanently removed from the Transportation Program. This is not an exhaustive list of all applicable Transportation Program policies. Aging Services reserves the right to change or discontinue the Transportation Program at any time based on participant or volunteer needs, changes in funding, organizational needs, safety concerns, or other currently known or unknown circumstances.

The transportation services you are receiving is paid for entirely or partially by funds from the federal Older Americans Act and the State of Iowa. Your responses on this form are confidential. This information is used to comply with reporting requirements and research the needs of older Iowans. Thank you.