Expense Reimbursement Form

Expense Reimbursement Form

All reimbursement forms are due by the 15th of each month. Approved payments will be processed with your second payroll check of the month.
Today's Date*

MonthDayYear
Date
Is this reimbursement for Malpractice or Liability Insurance?*

YesNo
Please reach out to our Credentialing team at credentialing@cprecovery.com for matters related to Malpractice or Liability Insurance, as this form is not applicable for those purposes.
Employee's Legal Name*

First NameLast Name
Employee's CPR Email Address*
example@cprecovery.com
Department*
Phone Number*
Only type the numbers.
Description of Purchase & Amount

MEALS: Receipts for meals must show:

Date, Place, Amount (should already be printed on receipt)

Participants and what was discussed (should be written in)
- Participant Name, Title, Company
- Provide enough detail to determing the nature of the meeting
Common Description of Purchases: Office Supplies, Parking, Education/Training, Travel/Lodging, Postage/Delivery
Total Amount of Purchase(s):*
Provide any additional details here:
Attach a copy of your receipt(s):*

Cancelof
Manager's Legal Name*

First NameLast Name
Manager's CPR Email Address*
example@cprecovery.com
Upon submission, this form will automatically be forwarded to your manager (as selected above) for approval. Following their approval, the Accounts Payable department will be alerted for processing. Additionally, you will receive a confirmation copy of the approval.
Manager Status*

ApprovedDenied
Reason for denial:*
Manager Signature:*
Please type in your signature.
Should be Empty: