MMA Expense Report Madison Medical Affiliates Expense Report Please use this form to report expenses and upload all receipts for the MMA Go Live Name* Is this a revised form?* No, this is my original expense summary Yes, this is a revised form If 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*This should not apply if you rented through Concur. If you rented outside of Concur, please include rental car costs here. If gas was paid separately, this will be reported later. 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 .575 per mile)Automatically calculated based on total miles driven. Miles driven reimbursed at 57 cents per mile for driving personal car. Do not include gas receipts if driving your personal car as the 57 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. Please be sure to upload the receipt at the end of this report.Total Hotel Costs*Hotels were direct billed to MDL. This figure should be zero. If you did have hotel costs please include a comment on why at the end of this report along with the receipt.Taxi/Uber Cost*Please include Uber charges here that were not direct billed to MDLTotal 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 (including drug screening requirements).Total Expense Report (Auto Calculation)Auto calculation of all expenses noted aboveExpense Report NotesEnter any notes here related to this expense report.Upload All Receipts Here Drop files here or Select files Max. file size: 32 MB.