To deduct medical expenses they must exceed 7.5% of your income and only that portion that exceeds 7.5% is deductible. For example, if you earn $50,000 as adjusted gross income, then only the medical expenses that exceed $3,750 are deductible. Please summarize your medical expenses and describe them below.

Here is the IRS list of Qualified Medical Expenses.

We do not need your receipts. If you have another log such as a spreadsheet or a summary, you can send that to us in lieu of completing this form.

Qualified Medical Expenses

Did you have any other travel expenses? Travel expenses are only deductible for the person receiving medical treatment, and in some cases a caretaker. If this applies to you, please explain below-

Do you have any other expenses such as caretakers, dentistry, medical supplies, etc?

Qualified Medical Expenses for Others

You are able to deduct medical expenses for others even if they do not qualify as a dependent but you must have provided over 50% of his or her support. For example, your mother earns over $12,400 and therefore cannot be your dependent. But, you provide over 50% of her support. You can deduct the medical expenses that you paid. So, if this applies to you, please describe below-

A bit of caution however. It does not make sense to pay for medical expenses if you cannot deduct them. For example, your same mother above might be able to deduct medical expenses because she has a much lower income. If she can deduct the medical expenses and you cannot because of income thresholds, you should gift the money to your mother and have her pay the expenses directly. She gets the deduction that otherwise would have been lost. Talk to us if you need help.

Health Savings Accounts (HSA)

HSAs are becoming more popular as employers move to consumer driven health plans (CDHPs). A form 1099-SA is used to report the tax consequence, however they typically do not provide all the information necessary for the preparation of your tax return.


If you received any 1099-SAs please provide a copy and complete the following. You can also jot this information down on the form as you send it in. A code W in Box 12 on your W-2 simply means that an HSA contribution was made by your employer and / or by you. You will only get a 1099-SA if you had withdrawals from your HSA.

Self / Single     Family

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