Free Healthcare Mileage Log Template
Healthcare Travel Mileage and Expenses Log
Prepared by: [Your Name]
Date: [DATE]
Company Name: [Your Company Name]
This log is designed to record mileage and associated expenses for healthcare-related travel. It provides a structured and professional approach to tracking travel distances and costs incurred during medical appointments, treatments, and visits, ensuring accurate documentation for reimbursement and financial reporting purposes.
Log Overview
|
DATE |
HEALTHCARE DESTINATION |
ODO READING (START - END) |
MILES TRAVELED |
EXPENSES |
|---|---|---|---|---|
|
2050-07-01 |
Dr. Smith’s Clinic |
50,000 - 50,120 |
120 |
$30 |
|
2050-07-05 |
PT Clinic |
50,120 - 50,180 |
60 |
$15 |
|
2050-07-10 |
Dr. Johnson’s Office |
50,180 - 50,250 |
70 |
$20 |
|
2050-07-15 |
General Hospital |
50,250 - 50,330 |
80 |
$25 |
|
2050-07-20 |
Diagnostic Center |
50,330 - 50,410 |
80 |
$30 |
|
2050-07-25 |
Emergency Room |
50,410 - 50,490 |
80 |
$40 |
Reminders:
-
Verify Dates: Ensure all dates are correct and match the travel schedule.
-
Check Mileage: Confirm mileage is accurately recorded using odometer readings or a tracking app.
-
Expense Receipts: Attach all receipts to the log for verification.
-
Review Reimbursements: Submit the log for reimbursement promptly at the end of each month.
-
Keep Copies: Maintain a backup copy of the log for your records.
