I don't have any paperwork to fill out. When I need reimbursed, I write myself a check. I could wait until the end of the year and give myself a $750 Christmas bonus since I can't expect to receive it from my employer but why bother waiting when the money is in there now? My account is on the trust system and it can be audited. If I use it for anything that I cannot substantiate as a medical expense or do not have a receipt for, then I could face tax consequences for using tax-sheltered money as contributions to the HSA use pre-tax dollars. Maybe other HSAs are not on the trust system though. I know that the flex spending account that I could also get through work requires paperwork.
I use the debit card for everything that I can (but so far that has only been at the pharmacy). I don't see any reason why I couldn't also use it at the doctor's office.
By the way, mine isn't really a debit card even though it says "debit" on it and is referred to as such in all of my literature. The bank that the HSA is through sent a PIN # but you can't run my card like that or get account information over the phone by using the PIN. None of my co-workers can use their PINs either. One even asked the bank last year why they send PINs when they don't work but they did not have an answer. We just have to sign for everything like it is a credit card.
My account is through Tower Bank in Ft. Wayne, IN and has been pretty messed up. First of all, when the checks arrived, they didn't have my husband's name even though he is a co-owner. I didn't push the issue since I handle all the finances anyway but everyone else's was also like this (at least one pushed the issue and got a new set of checks). My checks took over 2 months to arrive but got to my house within a week of me irritating them until they realized that they never actually sent the order to the check company. Until the checks arrived, I did not know the routing number or my account number because their website is terrible. You can't even do fund transfers on their website so you are forced to buy checks to do any reimbursements or for anything that you receive a bill in the mail for. They also sent the first debit card with an expiration date in 2001 and it took about 4 weeks to receive ones with an acceptable expiration date. To top it all off, I then received notification that they may have put my check images in with someone else's

(!?!?!?!) bank statement! So, they had to give me a new account number and ship me new checks that I had to wait about a month for (meaning I had to contact the ortho's office for the 3rd time in 4 months to request that they change the EFT account that my payments are taken from). Someone has to cover the extra debit cards (my husband and I both got a messed up one), that were sent out, worthless PINs (which of course without I didn't think that I could use the card since it says "debit" on it), my extra box of checks, and for the people who really push the issue to have the co-owner also listed on the checks, yet another box of checks. Who out there thinks that my service charges will be going up if I keep the account next year???