SSN 10. Receiptfinvolce Is: 11. Type of Unusual Expense: El Medically Necessary Item (Attached Supporting Statement) • Excess Lodging/Per Diem Ei Travel & Transportation • Pretrial Conference Waiver • Other 12. Explanation: 1 13. Start Date of Service (MO/DA/YR) 14. End Data of Senile. (MOIDANR) 15. Amount 2