Expense reimbursement form template

An expense reimbursement form template gives your practice one standard document for staff to claim back business costs they paid out of pocket. Ours is a free two-page PDF covering each expense, its receipt, manager approval, and the total finance pays back.

Claims sent as loose emails or spreadsheet rows tend to arrive late, without receipts, and filed under whatever category the employee picked. A set form gives every claim the same fields and the same approval route. Pair it with a written policy such as SHRM’s sample expense reimbursement policy.

The form also protects the tax treatment. Under IRS accountable plan rules, a reimbursement stays out of the employee’s taxable wages only when it’s substantiated within a reasonable time. A signed form with receipts attached is that substantiation.

Key takeaways

An expense reimbursement form records who paid for what, why it was a business cost, the receipt, and who approved the payback.

Every claim needs the employee’s name, date of expense, category, description, amount, receipt, and manager sign-off.

Healthcare practices get more from the form by adding a cost center, a patient-related flag, and the reimbursement method.

Under the IRS fixed date safe harbor, staff account for an expense within 60 days and return any excess within 120 days.

Practice software such as Pabau can collect the same fields through digital forms, and it integrates with Xero for accounting.

What is an expense reimbursement form?

An expense reimbursement form is the request a staff member fills in after paying a business cost themselves. It lets the practice check the cost against policy and pay them back. An expense report is broader, since it rolls up spending across a week or month and may track it against a budget.

In a healthcare practice, typical claims cover conference fees, continuing medical education (CME) courses, and office supplies. Some are tied to one patient, such as specialized equipment bought for their care. With a documented form, each request is tracked, each amount is checked against a receipt, and the approver is named on the page.

What to include on the form

The form needs two layers: fields every claim must carry, and optional fields that make healthcare claims easier to allocate and audit. The employee details should match the staff member’s employee info form, so finance can tie the claim to payroll without guessing.

Required fields

• Employee name and employee ID: identifies who is requesting reimbursement
• Date of expense: when the cost was incurred (not when the form is submitted)
• Expense category: classification (for example, training, supplies, travel, or meals) for budget tracking and policy review
• Description of expense: what was purchased and the business reason for it
• Amount: total cost, in the currency the practice uses
• Receipt attachment: proof of purchase (invoice, receipt, or card statement)
• Manager name and signature: approval by the employee’s direct supervisor or designated approver
• Date approved: when the manager signed off
• Total reimbursement amount: the verified total the practice will pay back, less any cash advance

Optional fields for healthcare practices

• Department or location: tracks costs by practice site or team for cost allocation
• Patient-related expense flag: marks a cost tied to one patient’s care, which helps with billing or patient-account tracking
• Reimbursement method: direct deposit, check, petty cash, or the next payroll run, so finance knows how to pay
• Cost center or purpose code: for practices that allocate spending with internal accounting codes
• Accounting reference number: links the payout to the practice’s accounting system for reconciliation
• Notes: space for the manager or finance team to record special circumstances

How to fill it out and process a claim

A claim moves through six steps, from download to filing.

1. Download the template: save the PDF to your practice’s shared drive, or print copies for the staff room.
2. Employee completes the form: one row per expense, with the date, category, description, and amount, plus the receipt.
3. Submit to the manager: the employee hands in the form before the practice deadline, often within 30 days of the expense.
4. Manager reviews and approves: the approver checks each row against policy and its receipt, then signs and dates the form.
5. Finance pays out: finance confirms the total and pays the employee by their chosen method. Practices that pay through payroll add the amount to the next run, which is where healthcare payroll software takes over.
6. File for records: the signed form and receipts go into the employee’s expense history and the practice’s financial records.

Printable PDF or digital form?

The template comes as a two-page PDF. Print it for staff who prefer paper, or mark it up on screen in a PDF editor before it goes to the manager for signature.

Once claims arrive every week, paper slows approval down. Rebuild the same fields as a digital form in your practice software, and submissions arrive complete and sit in one place.

IRS deadlines that keep reimbursements tax-free

IRS Publication 463 sets out the accountable plan rules. A reimbursement stays tax-free for the employee when it has a business purpose, it is substantiated, and any excess goes back to the practice.

The publication also defines a reasonable time through a fixed date safe harbor. An advance is paid no more than 30 days before the expense. The employee then accounts for the expense within 60 days and returns any excess within 120 days.

Your own submission deadline should sit well inside that 60-day window, as the timeline below shows.

Receipts have a threshold of their own. Publication 463 asks for documentary evidence, such as a receipt, for any lodging expense and for other expenses of $75 or more. A practice rule that asks for more than that is stricter than the IRS, which is fine.

Reimbursement policy rules for healthcare practices

The form works best with a written policy behind it. Add these rules to your staff handbook and to your HR compliance checklist.

• Set a clear reimbursement policy: list which expense categories are reimbursable, any dollar limits, and the submission deadline. Share it with staff at hire and during onboarding.
• Decide your receipt rule: the template asks for a receipt on every row, which is the simplest rule to enforce. If you accept small petty-cash items without one, put the threshold (for example, $25) in writing.
• Use consistent expense categories: match categories to your accounting or budget structure so finance can allocate costs quickly. The template’s key covers training, office supplies, patient care supplies, travel, meals, and other.
• Set a submission deadline: ask for claims within 30 days of the expense. That keeps the backlog small and leaves room inside the IRS 60-day window.
• Define approval authority: state which manager level approves claims. Say whether large expenses (for example, over $500) need a second sign-off from practice leadership or finance.
• Keep claims in one place: store every submitted form and its approval together, so finance can pull any employee’s expense history in minutes.

How Pabau helps you collect and track expense claims

Paper forms and email attachments work for a handful of claims a month. As the team grows, receipts go missing and finance spends month-end chasing signatures.

Pabau, the software for practice managers we build, lets you recreate this template’s fields as digital forms. Staff complete the claim on screen, and the finished form is stored in Pabau instead of a shared inbox.

Pabau also integrates with Xero, so invoices and payments from the practice land in the same books your finance team reconciles staff claims against. Its staff management tools keep rotas and timesheets for the same team in one system.

Collect expense claims without the paper chase

Pabau’s digital forms capture each claim field in one place, and its Xero integration keeps invoices and payments in your books. Staff stop emailing receipts, and managers stop chasing missing forms.

Book a demo

Conclusion

Start with the PDF and a one-page policy. Name the categories you reimburse, your receipt rule, a 30-day deadline, and who signs off above which amount. That combination removes the usual causes of late and incomplete claims.

The trade-off is admin time. Paper forms cost nothing to start with, but every claim still needs printing, signing, and filing by hand. Once claims arrive weekly, moving the same fields into digital forms saves more time than it costs.

Either way, the IRS 60-day window is the line to protect. Book a demo to see how Pabau can collect your practice’s expense claims on screen and keep them filed for audit.

Continue your research

Choosing how to pay staff? 9 best healthcare payroll software platforms compares the payroll tools that can pay out approved claims.

Documenting a policy breach? Employee counseling form gives you the fields and signatures to record issues fairly.

Planning staff reviews? Annual review template for healthcare practices includes sample comments and SMART goal examples.

Frequently asked questions