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 1/1/21
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 2020