Make a Plan tracker

Attachment 18b

MAKE A PLAN

TO BE PART OF

DOORSTEP
INTERVIEW

MY INTERVIEW

Congratulations!
You’ve been
selected!

In-home Interview
DATE:

CS274802-G

TIME:

MY RIDE

MY EXAM

Plan how you will get
to your health exam at
the NHANES mobile
unit.

Go to the NHANES
mobile unit for
your exam
DATE:

I’M DONE!

Thank you
for helping
your
community

TIME:

For more information about NHANES visit www.cdc.gov/nchs/NHANES or call _____________________
U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION

MAKE A PLAN
DOORSTEP
INTERVIEW

Congratulations!
You’ve been
selected!

TO BE PART OF

MY INTERVIEW

In-home
interview
DATE:

CS274802-G

TIME:

MY RIDE

MY EXAM

Plan how you will get
to your health exam at
the NHANES mobile
unit. You will receive
an incentive to help
with your out of
pocket expenses.

Go to the NHANES
mobile unit for
your exam
DATE:

I’M DONE!

Thank you
for helping
your
community

TIME:

For more information about NHANES visit www.cdc.gov/nchs/NHANES or call _________________________
U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION