Medical mileage expense form

If you need a medical mileage expense form for a year not listed here, please contact the Information and Assistance Unit at your closest district office of the Workers’ Compensation Appeals Board.

Form name

Word version
 
Medical mileage expense form - English/Spanish
* For travel on or after 1/1/20
version
Medical mileage expense form - English/Spanish
* For travel on or after 1/1/19
version
Medical mileage expense form - English/Spanish
* For travel on or after 1/1/18
version
Medical mileage expense form - English/Spanish
* For travel on or after 1/1/17
version
Medical mileage expense form - English/Spanish
* For travel on or after 1/1/16
version

March 2020