Trip Authorization Request #864BZ3PC
For Trip #1526431NKR1
not scheduled scheduled status: approved
Customer Information
Kessler Saddlebrook
Colita Mathews' Byrd
(201) 368-6060
cmatthewsbyrd@kessler-rehab.com
Payer Information
Kessler Saddlebrook
Colita Mathews' Byrd
(201) 368-6060
cmatthewsbyrd@kessler-rehab.com
Passenger Information
Patricia Phillips
168 lbs
Depart
300 Market St
Jul 01, 2022
| Ride ID | Departure | Arrival | Travel Time | Vehicle |
|---|---|---|---|---|
| #274980PNSVT |
06:00 AM
300 Market St, Saddle Brook, NJ 07663, USA
|
06:10 AM
30 Prospect Ave, Hackensack, NJ 07601, USA
|
10m
|
Wheelchair Accessible Van |
Additional Info
Dispatch Location
Livingston
Est. Loading Duration
15 mins.
Reason
Radiology
Depart
30 Prospect Ave
Jul 01, 2022
| Ride ID | Departure | Arrival | Travel Time | Vehicle |
|---|---|---|---|---|
| #274981CDG1R |
08:00 AM
30 Prospect Ave, Hackensack, NJ 07601, USA
|
08:09 AM
300 Market St, Saddle Brook, NJ 07663, USA
|
9m
|
Wheelchair Accessible Van |
Additional Info
Dispatch Location
Livingston
Est. Loading Duration
15 mins.
Reason
Radiology
Quantity
Description
Unit Price
1
Mileage Charge
$10.50
1
Pickup Charge
$38.00
Return Ride
1
Mileage Charge
$10.50
1
Pickup Charge
$38.00
Total
$97.00
| Name | Kessler Institute Rehab-Saddle Brook |
| Field | Value |
|---|---|
| Loaded Miles | 3.00 mi |
| Field | Value |
|---|---|
| Loaded Miles | 3.00 mi |
Pricing
$97.00
Status
Approved