Get Medical Expense Report Template

This guide provides you with a straightforward approach to filling out the Medical Expense Report Template online. It will help you understand each section and field of the form, ensuring that your submissions are accurate and complete.

Follow the steps to accurately fill out your Medical Expense Report Template.

1. Click the ‘Get Form’ button to access the Medical Expense Report Template. This will open the form in your online editor for you to start entering your information.
2. Begin filling in the 'Name of Veteran' field with the full name of the veteran, including their first, middle, and last names. This ensures that the report can be accurately linked to the correct individual.
3. Enter the 'VA File Number' to associate the report with the veteran's records. If you do not have this number, please contact the VA for assistance.
4. Provide the 'Name and Address of Claimant' in section 3A. This should be the person submitting the report, which may differ from the veteran in some cases.
5. If there is a change of address, check the box in section 3B to indicate that the address provided is different from the last address on record with VA.
6. Fill out section 3C with your e-mail address if applicable, which may be used for communication regarding your submission.
7. Enter the 'Veteran's Social Security Number' in section 4 to help verify the identity of the veteran associated with the report.
8. In section 5, begin itemizing your medical expenses. For each expense, list the purpose in column A, amount paid by you in column B, date paid in column C, name of provider in column D, and whom the expense was paid for in column E.
9. Repeat the previous step for all relevant medical expenses incurred during the specified period. If you need additional space, attach a separate sheet with corresponding columns.
10. For section 6, provide your daytime and evening telephone numbers in sections 6A and 6B respectively to ensure that VA can contact you if needed.
11. Sign the form in section 7A, ensuring you do not print your name. An unsigned form will be returned, so it is crucial to complete this step.
12. Finally, review all provided information for accuracy, then save your changes, and download, print, or share the form as necessary.

Complete your Medical Expense Report Template online today to ensure your medical expenses are considered for your claim.