MCS Time & Expense Report
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| T & E's ARE DUE BY MIDNIGHT ON THE 5th AND 19th
OF EVERY MONTH. PLEASE SUBMIT SOONER IF POSSIBLE. WHEN YOU ARE DONE FILLING IN
THIS FORM, PLEASE PRINT IT AND FAX IT TO US WITH COPIES OF YOUR RECEIPTS.
PLEASE REMEMBER TO MAIL ORIGINAL T & E SIGNED ALONG WITH YOUR ORIGINAL
RECEIPTS. FAX: 315-638-6309 OR EMAIL THIS FORM BACK. |
| DATE: |
HOSPITAL / LOCATION |
CHARTS/TYPE COMPLETED |
HOURS WORKED |
HOURS TRAVELED |
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PERSONAL AUTO |
MEALS |
TOLLS |
PARKING |
DAILY TOTAL |
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MILES |
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COLUMN TOTALS |
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ADDITIONAL EXPENSES |
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RENTAL CAR/GAS |
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CAB FARE or SHUTTLE |
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HOTEL EXPENSE |
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TOTAL |
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| Instructions: For all consulting time worked, a Time
& Expense Report MUST be completed and submitted. (E-mailing the
information is acceptable with the understanding that we fill out the T&E
from the information given OR you can email this completed form back.) Original
receipts MUST be attached to this form in order to be reimbursed. (If faxing,
include copies of receipts and send originals ASAP. If e-mailing, fax copies of
receipts and put original receipts in the mail to us ASAP.) |
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Conditions: Meals: during normal business hours are
not reimbursed unless you are consulting out of town (if commuting back and
forth from home, meals are not reimbursed).
Travel: You will be paid travel time only if the hospital pays travel time. The
consultant is responsible for the first hour of travel to their destination and
again the first hour on their return home. Mileage is reimbursed at 35 cents
per mile if your travel time, one way, is greater than an hour. |
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| I understand that original receipts must be sent to
MCS as soon as possible in order for reimbursement not to be affected. I also
understand that when I am out of town overnight on MCS business, I MUST obtain
an itemized copy of all hotel expenses when I check out (or at T&E
deadline, if sooner). If I do not obtain the hotel billing information, I am
aware that I may be charged for hotel expenses. I also certify that all of the
above information is true and correct.
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MAILING ADDRESS:
MCS,
60 OSWEGO STREET
BALDWINSVILLE, NY 13027
PHONE: 800-627-8588
FAX: 315-638-6309 |