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Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates..
Please select the items you are submitting for payment:* Check all that apply. Amount of final reimbursement will be based on contracted rates and adjusted for multiple coverage.
APP Live Teaching Reimbursement* Please complete this inventory to submit your time for reimbursement. Budgeting includes a single APP in the morning sessions for both days, 3 APPs in the Day 1 afternoon session, and 2 APPs in the Day 2 Afternoon session. Sessions may be split between multiple providers, and reimbursement will be divided accordingly based on single session rates and the number of APPs who are present. Payments will be made no later than the 15th of each month. Payment for events occurring after the 15th may not be processed until the next pay date on the next month.
APP Live Teaching Reimbursement* Please complete this inventory to submit your time for reimbursement. Budgeting includes a single APP in the morning sessions for both days, 3 APPs in the Day 1 afternoon session, and 2 APPs in the Day 2 Afternoon session. Sessions may be split between multiple providers, and reimbursement will be divided accordingly based on single session rates and the number of APPs who are present. Payments will be made no later than the 15th of each month. Payment for events occurring after the 15th may not be processed until the next pay date on the next month.
Physician Live Teaching Reimbursement* Please complete this inventory to submit your time for reimbursement. Only one physician will be budgeted for each session. Sessions may be split between multiple physicians, divided equally, and reimbursement will be divided accordingly. Payments will be made no later than the 15th of each month. Payment for events occurring after the 15th may not be processed until the next pay date on the next month.
Physician Live Teaching Reimbursement* Please complete this inventory to submit your time for reimbursement. Only one physician will be budgeted for each session. Sessions may be split between multiple physicians, divided equally, and reimbursement will be divided accordingly. Payments will be made no later than the 15th of each month. Payment for events occurring after the 15th may not be processed until the next pay date on the next month.
Physician Live Teaching Reimbursement* Please complete this inventory to submit your time for reimbursement. Only one physician will be budgeted for each session. Sessions may be split between multiple physicians, divided equally, and reimbursement will be divided accordingly. Payments will be made no later than the 15th of each month. Payment for events occurring after the 15th may not be processed until the next pay date on the next month.
APP Live Teaching Reimbursement* Please complete this inventory to submit your time for reimbursement. Budgeting includes a single APP in the morning sessions for both days, 3 APPs in the Day 1 afternoon session, and 2 APPs in the Day 2 Afternoon session. Sessions may be split between multiple providers, and reimbursement will be divided accordingly based on single session rates and the number of APPs who are present. Payments will be made no later than the 15th of each month. Payment for events occurring after the 15th may not be processed until the next pay date on the next month.
APP Live Teaching Reimbursement* Please complete this inventory to submit your time for reimbursement. Budgeting includes a single APP in the morning sessions for both days, 3 APPs in the Day 1 afternoon session, and 2 APPs in the Day 2 Afternoon session. Sessions may be split between multiple providers, and reimbursement will be divided accordingly based on single session rates and the number of APPs who are present. Payments will be made no later than the 15th of each month. Payment for events occurring after the 15th may not be processed until the next pay date on the next month.
Sonographer Teaching Reimbursement* Please complete this invoice. Sonographer pay is for a maximum of 6 hours (10am – 4pm). Lead Sonographer pay is for 9 hours (8am – 5pm). Payments will be made no later than the 15th of each month. Payment for events occurring after the 15th may not be processed until the next pay date on the next month.
How far do you live from the program where you taught? Did your food and beverage expenses exceed $100.00?* You are limited to $50.00 per day, for two days, of reimbursement. The maximum reimbursement of $100.00 will be applied if you did exceed this amount. Please submit receipts for all expenses.
Did your food and beverage expenses exceed $100.00?* You are limited to $50.00 per day, for two days, of reimbursement. The maximum reimbursement of $100.00 will be applied if you did exceed this amount. Please submit receipts for all expenses.
Did your food and beverage expenses exceed $100.00?* You are limited to $50.00 per day, for two days, of reimbursement. The maximum reimbursement of $100.00 will be applied if you did exceed this amount. Please submit receipts for all expenses.
Did your food and beverage expenses exceed $100.00?* You are limited to $50.00 per day, for two days, of reimbursement. The maximum reimbursement of $100.00 will be applied if you did exceed this amount. Please submit receipts for all expenses.
Did your food and beverage expenses exceed $100.00?* You are limited to $50.00 per day, for two days, of reimbursement. The maximum reimbursement of $100.00 will be applied if you did exceed this amount. Please submit receipts for all expenses.
Did your food and beverage expenses exceed $100.00?* You are limited to $50.00 per day, for two days, of reimbursement. The maximum reimbursement of $100.00 will be applied if you did exceed this amount. Please submit receipts for all expenses.
Did your food and beverage expenses exceed $100.00?* You are limited to $50.00 per day, for two days, of reimbursement. The maximum reimbursement of $100.00 will be applied if you did exceed this amount. Please submit receipts for all expenses.
Work performed for website design, art, or marketing:* Please provide a brief description of the work you performed. THIS SHOULD NOT BE USED FOR TEACHING, TRAVEL, BLOG, or CONTENT DEVELOPMENT REIMBURSEMENT
Are you contracted hourly?* We are sorry, but travel is not reimbursed if you live less than 50 miles from the location of the course.
Management Fee Make Bonus Payment Select the staff member who qualifies for bonus payments.
Month of Event* 
