Free Medical Mileage Log Template
Medical-Related Travel Mileage Log
Prepared by: [Your Name]
Date: [DATE]
Company Name: [Your Company Name]
This log is designed to record mileage for medical-related travel. It provides a systematic and professional approach to tracking travel distances associated with medical appointments, treatments, and visits, ensuring accurate documentation for reimbursement and reporting purposes.
Log Overview
|
DATE |
MEDICAL TRIP PURPOSE |
ODO READING (START - END) |
MILES TRAVELED |
HEALTHCARE FACILITY |
|---|---|---|---|---|
|
2050-07-01 |
Doctor Appointment |
50,000 - 50,120 |
120 |
Dr. Smith |
|
2050-07-05 |
Physical Therapy |
50,120 - 50,180 |
60 |
PT Clinic |
|
2050-07-10 |
Specialist Consultation |
50,180 - 50,250 |
70 |
Dr. Johnson |
|
2050-07-15 |
Hospital Visit |
50,250 - 50,330 |
80 |
General Hospital |
|
2050-07-20 |
Diagnostic Testing |
50,330 - 50,410 |
80 |
Diagnostic Center |
|
2050-07-25 |
Emergency Visit |
50,410 - 50,490 |
80 |
Emergency Room |
Notes
-
Date: The date when the mileage was recorded for medical-related travel.
-
Medical Trip Purpose: Describes the reason for the travel, such as appointments, treatments, or follow-ups, providing context for the trip.
-
ODO Reading (Start - End): Combined odometer readings at the start and end of the travel period, ensuring precise tracking of distances.
-
Miles Traveled: The total distance traveled during the trip, essential for accurate reporting and reimbursement.
-
Healthcare Facility: The name of the medical facility or practitioner visited during the trip, providing specific context for the travel.
