Travel Assignment information:

Assignment Date:
  to
Hospital Name:
Hospital Address:
(city, state)
Hospital Contact Name:
Hospital Telephone Number:
Transportation
Mileage to Assignment
AirFare
Commuting Mileage
Rental Costs
Car rental
Moving Rental
Parking Fees
Bus / Train Fares
Tolls
*Retain Copies of you schedule with your log to take advantage of mileage to and from the facility you are working for.
Housing (if not reimbursed or paid by your Agency)
Rent
Gas
Electric
Water/Sewer
Trash
Phone
Landline
Cell phone
Cable / Internet
Insurance
Laundry
Miscellaneous Expenses
Professional Fees
Malpractice Insurance
State License Fees (Not Reimbursed)
Association Dues
Continuing Education
Professional Publications / Journals
Other
Miscellaneous Expenses
Food
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