CARE+ Expense Form

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CARE+ Expense Requests must be submitted within 2 months of the expense date on the verifying receipt. Requests submitted later will not be approved. 

If you are submitting requests for multiple CARE+ Expenses in one month, please complete one form for all CARE+ Expense Requests. 

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Travel











Airport Transfer


Car Transport




Train Transport





OTC Medication





Therapies for GD not covered by Insurance





Emergency Contact Information