JHAH Expense Report JHAH Go Live Expense Report Please use this form to report expenses and upload all receipts. If this is a revised form, please be sure to mark that it's a revised form in question 2. Original forms will be deleted if revised forms are sent in so please be sure to include ALL expenses on the revised form (rather than just missed expenses from the original form). Please enter 0 in required expense fields if you have no expenses. Please do not include per diem expenses as these will be calculated separately based on your total shifts. Name*Is this a revised form?*No, this is my original expense summaryYes, this is a revised formIf this is a revised form, the original form will be deleted. Please include all expenses even if already submitted in a prior form.Email* Total Rental Car Costs*Please include the total cost of the rental car here. If gas was paid separately, this will be reported later. Please be sure that this number reconciles to the amount per the receipt that will be attached later. If you rented with National or Enterprise thru Concur the charges would have been direct billed to us making this entry $0.Rental Car Gas*Please include total gas for rental car here. If you drove your own car you will be reimbursed based on miles. Do NOT include gas if you drove your own car. If gas was pre-paid and already included in the rental car cost, do not include here as it will be a duplicate.Total Miles Driven in Personal Car*If you rented a car this value will be 0. If you drove your own car please include the total miles driven for the project. The reimbursed $ amount will be automatically calculated below.Miles Reimbursed as $ (Auto Calculation .54 per mile)Automatically calculated based on total miles driven. Miles driven reimbursed at 54 cents per mile for driving personal car. Do not include gas receipts if driving your personal car as the 54 cents cover all costs. If you rented a car do NOT report miles driven, however DO report gas costs (if not included in your rental car receipt).Total Airfare Costs*All flights booked through Concur are MDL paid, therefore do not include those costs above. Misc. flight fees will be reported later. Only include airfare costs if you booked flight yourself rather than using Concur.Total Hotel Costs*In the rare case that your hotel was not the MDL preferred hotel and you paid for the room yourself, please include the total cost here. Please upload the receipt later in the form. If you stayed at the MDL hotel all charges were billed to MDL and this figure would = $0.Total Cost of Taxi/Ubers*Please include cab / ride share charges here. Please upload all receipts associated with these charges later in form.Total Cost of Flight Fees*If you incurred flight fees that were billed to your personal credit card (rather than billed to MDL) please include those costs here. The most common fee would be baggage fee. Please upload receipt later in the report if necessary.Total Other Expenses (Do not include per diem)*Include any other expenses incurred here. DO NOT include per diem as this will be calculated separately based on your total shifts. Please also upload all necessary receipts for other expenses.Total Expense Report (Auto Calculation)Auto calculation of all expenses noted aboveExpense Report NotesEnter any notes here related to this expense report.Upload Receipts Here Drop files here or Please upload receipts here. If possible please combine all receipts into one file (preferably PDF). If you can't combine into one file, please use the following upload links to upload receipts one at a time.