Medical Expenses Worksheet

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Complete Medical Expenses Worksheet with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

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Tax Payer
Spouse
For clients age 63 as of December 31, 2016
Medical Expenses
Taxpayer
Spouse
Insurance Premiums medical, dental & vision
Medicare Insurance
Long Term Care Premiums
Prescriptions
Doctors
Dentists
Eyeglasses and Contact Lenses
Hospitals
Nursing Home
In Home Care
Hearing Aids and Batteries
Chiropractors
Other _____________
Other _____________
Other _____________
Total Medical Expense
-
-
Medical Miles
Please provide your medical expense for each category above. We do not need
receipts, please keep the receipts for your records.

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Parent category: Medical
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