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 |
|---|
| Medical mileage expense form - English/Spanish
* For travel on or after 1/1/24 |
| Medical mileage expense form - English/Spanish
* For travel on or after 1/1/23 |
| Medical mileage expense form - English/Spanish
* For travel on or after 7/1/22 |
Medical mileage expense form - English/Spanish
* For travel on or after 1/1/22 |
| Medical mileage expense form - English/Spanish
* For travel on or after 1/1/21 |
| Medical mileage expense form - English/Spanish
* For travel on or after 1/1/20 |
| Medical mileage expense form - English/Spanish
* For travel on or after 1/1/19 |
| Medical mileage expense form - English/Spanish
* For travel on or after 1/1/18 |
| Medical mileage expense form - English/Spanish
* For travel on or after 1/1/17 |
December 2023