Since you asked this in the Taxes forum I assume you're asking a about what tax form you should file with your income tax return to avoid the 10% early withdrawal penalty. You use form 5329 to document that the withdrawal was due to unreimbursed medical costs. This allows you to avoid the 10% early withdrawal penalty, but only to the extent that your medical expenses exceed 7.5% of your adjusted gross income. Of course you still pay ordinary income tax on the withdrawal (federal plus state/local as appropriate).