Attachment 12 – HC MEPS Monthly Planner

12-HC MEPS Monthly Planner.pdf

Medical Expenditure Panel Survey (MEPS) COVID-19 Changes

Attachment 12 – HC MEPS Monthly Planner

OMB: 0935-0118

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OMB #0935-0118
15-201

2015 Monthly Planner
41962.0914.6050020301

Eyeglasses or contact lenses
Diabetic equipment and supplies, including insulin
Ambulance services
Crutches, wheelchairs, and other
health-related equipment

n

	
n	
n	
n	

The date
The name of the provider
The reason for the visit or medical expense
Charges and payments

For each event, note:

n

	
n	
n	
n	

Also record other medical expenses:

19
26

24
25
31

19
26

24
25
31

27

20

28

21

14

29

22

15

30

23

16

9

28

21

14

7

18

13

8

29

22

15

8

30

23

16

9

2

Tu

17

12

7

1

M

11

6

2

10

5

Sa

F
1
4

23

3

Th

29

22

16

Su

Tu

W

28

21

15

M

30

23

14

Su

29

22

16

9

August 2016

28

21

15

8

July 2016

27

20

14

9

7

18

13

8

31

24

17

10

3

W

24

17

10

3

W

17

12

7

2

Tu

11

6

1

M

10

5

2
4

Sa

F
1
3

Th

Su

W

M

Su

Tu

February 2016

January 2016

2016

25

18

11

4

Th

25

18

11

4

Th

F

26

19

12

5

F

26

19

12

5

27

20

13

6

Sa

27

20

13

6

Sa

28

21

14

7

M

29

22

15

8

1

Tu

30

23

16

9

2

W

25

18

11

4

Su

26

19

12

5

M

27

20

13

6

Tu

28

21

14

7

W

September 2016

27

20

13

6

Su

March 2016

29

22

15

8

1

Th

31

24

17

10

3

Th

F

30

23

16

9

2

F

25

18

11

4

24

17

10

3

Sa

26

19

12

5

Sa

25

18

11

4

M

26

19

12

5

Tu

27

20

13

6

W

17

10

3

M

18

11

4

Tu

23 24
25
30 31

16

9

2

Su

26

19

12

5

W

October 2016

24

17

10

3

Su

April 2016

27

20

13

6

Th

28

21

14

7

Th

F

28

21

14

7

F

29

22

15

8

1

29

22

15

8

1

Sa

30

23

16

9

2

Sa

30

23

16

9

2

M

31

24

17

10

3

Tu

25

18

11

4

W

27

20

13

6

Su

28

21

14

7

M

29

22

15

8

1

Tu

30

23

16

9

2

W

November 2016

29

22

15

8

1

Su

May 2016

24

17

10

3

Th

26

19

12

5

Th

F

25

18

11

4

F

27

20

13

6

26

19

12

5

Sa

28

21

14

7

Sa

27

20

13

6

M

28

21

14

7

Tu

29

22

15

8

1

W

25

18

11

4

Su

26

19

12

5

M

27

20

13

6

Tu

28

21

14

7

W

December 2016

26

19

12

5

Su

June 2016

29

22

15

8

1

Th

30

23

16

9

2

Th

30

23

16

9

2

F

24

17

10

3

F

31

24

17

10

3

Sa

25

18

11

4

Sa

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Notes

n

	V
 isits to a doctor, dentist, or other health care
provider such as a physical therapist,
chiropractor, or optometrist
n	 Visits to a clinic or HMO
n	 Hospital stays
n	 Visits to an emergency room
n	 Visits to an outpatient department of a hospital
n	 Visits for blood tests, X-rays, or other tests
n	 T
 elephone calls to obtain test results or
medical advice
n	 Admissions to a nursing home
n	 
Care received at home from a home health care
provider, doctor, nurse, or other health care person
n	 
Prescriptions for medicines that were filled
or refilled

Use it to make notes about all types of
health care events:

This monthly planner is provided as a convenient way to keep track of health care events for
your family. These events will be asked about during the MEPS interview.

2015 Monthly Planner

27

26

30

26

25

28

29

30

23

31

24

25

18

26

12

5

19

17

11

4

18

16

10

3

23 24
25
30 31

9

2

27

22

17

11

Tu

26

21

16

10

M

20

15

9

4

19

14

8

3

13

7

2

1

W

25

12

24

6

23

18

5

Th

W

Sa

22

17

Su

Tu

F

31

24

16

4
11

M

30

23

15

10

Su

29

22

17

9

3

August 2015

28

21

16

8

2

July 2015

27

20

15

10

1

W

19

14

9

3

Tu

18

13

8

2

1

M

12

7

F

Th

11

6

W

5

Tu

4

27

Su

26

24
25
31

20

13

February 2015

19

18

17

12

6

M

Sa

26

11

5

Su

31

25

10

4

W

26

19

12

5

January 2015

2015

29

24

19

3

28

23

18

12

Tu

27

22

17

11

M

21

16

10

5

20

15

9

4

14

8

3

13

25

18

7

Sa

24

17

6

2

1

F

23

16

11

Su

W

Tu

Th

25

10

M

31

24

9

Su

30

23

18

4

August 2014

29

22

17

3

July 2014

28

21

16

11

2

20

15

10

W

19

14

9

Tu

13

8

M

12

7

4

6

3

5

2

1

Su

Th

W

M

Su

Tu

February 2014

January 2014

27

20

13

6

Th

26

19

12

5

Th

28

21

14

7

Th

27

20

13

6

28

21

14

7

F

27

20

13

6

F

29

22

15

8

1

F

28

21

14

7

29

22

15

8

1

Sa

28

21

14

7

Sa

30

23

16

9

2

Sa

22

15

8

1

29

22

15

8

1

M

30

23

16

9

2

Tu

30

23

16

9

2

M

31

24

17

10

3

Tu

25

18

11

4

W

24

17

10

3

W

27

20

13

6

Su

28

21

14

7

M

29

22

15

8

1

Tu

30

23

16

9

2

W

September 2015

29

22

15

8

1

Su

March 2015

28

21

14

7

Su

September 2014

26

12

5

23 24
25
30 31

11

4

Tu

19

17

10

3

M

18

16

9

2

Su

24

17

10

3

Th

26

19

12

5

Th

25

18

11

4

Th

27

20

13

6

25

18

11

4

F

27

20

13

6

F

26

19

12

5

F

28

21

14

7

26

19

12

5

Sa

28

21

14

7

Sa

27

20

13

6

Sa

29

22

15

8

1

Sa

28

21

14

7

M

29

22

15

8

1

Tu

30

23

16

9

2

27

20

13

6

M

28

21

14

7

Tu

27

20

13

6

M

28

21

14

7

Tu

29

22

15

8

1

W

29

22

15

8

1

W

25

18

11

4

Su

26

19

12

5

M

27

20

13

6

Tu

28

21

14

7

W

October 2015

26

19

12

5

Su

April 2015

26

19

12

5

Su

October 2014

27

20

13

6

Su

W

29

22

15

8

1

Th

30

23

16

9

2

Th

30

23

16

9

2

Th

24

17

10

3

Th

30

23

16

9

2

F

24

17

10

3

F

31

24

17

10

3

F

25

18

11

4

F

31

24

17

10

3

Sa

25

18

11

4

Sa

25

18

11

4

Sa

26

19

12

5

Sa

26

19

12

5

M

27

20

13

6

Tu

28

21

14

7

17

10

3

M

25

18

11

4

Tu

26

27

20

13

6

W

26

19

12

5

W

29

22

15

8

1

Su

30

23

16

9

2

M

24

17

10

3

Tu

25

18

11

4

W

November 2015

19

12

5

Tu

18

17

11

4

M

24
25
31

10

3

Su

May 2015

23
24
30

16

9

2

Su

November 2014

25

18

11

4

Su

W

26

19

12

5

Th

28

21

14

7

Th

27

20

13

6

Th

29

22

15

8

1

Th

27

20

13

6

F

29

22

15

8

1

F

28

21

14

7

F

30

23

16

9

2

F

28

21

14

7

Sa

30

23

16

9

2

Sa

29

22

15

8

1

Sa

31

24

17

10

3

Sa

30

23

16

9

2

M

24

17

10

3

Tu

25

18

11

4

29

22

15

8

1

M

30

23

16

9

2

Tu

29

22

15

8

1

M

30

23

16

9

2

Tu

24

17

10

3

W

31

24

17

10

3

W

27

20

13

6

Su

28

21

14

7

M

29

22

15

8

1

Tu

30

23

16

9

2

W

December 2015

28

21

14

7

Su

June 2015

28

21

14

7

Su

December 2014

29

22

15

8

1

Su

W

31

24

17

10

3

Th

25

18

11

4

Th

25

18

11

4

Th

26

19

12

5

Th

25

18

11

4

F

26

19

12

5

F

26

19

12

5

F

27

20

13

6

F

26

19

12

5

Sa

27

20

13

6

Sa

27

20

13

6

Sa

28

21

14

7

Sa

_________________________________________

_________________________________________

F

_________________________________________

_________________________________________

Th

_________________________________________

_________________________________________

W

_________________________________________

_________________________________________

Sa

_________________________________________

_________________________________________

F

_________________________________________

_________________________________________

Th

_________________________________________

_________________________________________

Sa

_________________________________________

_________________________________________

F

_________________________________________

_________________________________________

June 2014

_________________________________________

_________________________________________

May 2014

_________________________________________

_________________________________________

April 2014

_________________________________________

_________________________________________

March 2014

_________________________________________

_________________________________________

2014

Phone Numbers

Important Dates

16

9

2

Thursday

17

10

3

Easter

27

First day of Spring

28

21

29

22

30

23

31

24

15

8

1

Wednesday

20

14

13

Tuesday

St. Patrick’s Day

7

6

Monday

Daylight Saving Time begins

Sunday

January 2015

25

18

11

4

Good Friday

Friday

Saturday

26

19

12

5

Sunday

19

18

25

12

11

26

Martin Luther King, Jr. Day

5

4

Monday

March 2016
Tuesday

27

20

13

6

7

28

21

14

Wednesday

1

29

22

15

8

New Year’s Day

Thursday

Friday

30

23

16

9

2

Saturday

31

24

17

10

3

14

7

8

1

22

29

28

Presidents Day

15

Chinese New Year

Monday

21

Valentine’s Day

Sunday

Tuesday

February 2015

23

16

9

2

3

24

17

10

Wednesday

Thursday

25

18

11

4

Friday

26

19

12

5

Saturday

27

20

13

6

Sunday

16

15

22

9

8

23

Presidents Day

2

1

Monday

Tuesday

February 2016

24

17

10

3

4

25

18

11

Wednesday

19

12

5

26

Chinese New Year

Thursday

Friday

27

20

13

6

14

7

28

21

Valentine’s Day

Saturday

24

Sunday

18

17

31

11

10

25

Martin Luther King, Jr. Day

4

3

Monday

March 2015
Tuesday

26

19

12

5

6

27

20

13

Wednesday

Thursday

28

21

14

7

1

29

22

15

8

New Year’s Day

Friday

Saturday

30

23

16

9

2

2

9

8

Monday

1

16

23

30

15

22

29

Daylight Saving Time begins

Sunday

January 2016

17

10

3

31

24

St. Patrick’s Day

Tuesday

4

25

18

11

Wednesday

Thursday

26

19

12

5

20

13

6

27

First day of Spring

Friday

Saturday

28

21

14

7

Sunday

14

21

28

20

27

First day of Hanukkah

7

13

6

Monday

April 2015

22

15

8

1

29

First day of Winter

Tuesday

9

2

30

23

16

Wednesday

Thursday

31

24

17

10

3

25

18

11

4

Christmas Day

Friday

26

19

12

5

First day of Kwanzaa

Saturday

Sunday

13

20

27

19

26

6

12

Easter

5

Monday

Tuesday

December 2015

28

21

14

7

8

1

29

Earth Day

22

15

Wednesday

Thursday

30

23

16

9

2

3

24

17

10

Good Friday

Friday

4

25

18

11

First day of Passover

Saturday

1

16

23

30

15

22

29

2

9

Monday

8

Daylight Saving Time ends

Sunday

May 2015
Tuesday

24

17

10

3

4

25

18

Veterans Day

11

Wednesday

26

19

12

5

Thanksgiving

Thursday

Friday

27

20

13

6

Saturday

28

21

14

7

24

11

10

31

17

Memorial Day

25

18

4

Monday

3

Mother’s Day

Sunday

Tuesday

November 2015

26

19

12

5

6

27

20

13

Wednesday

Thursday

28

21

14

7

Friday

29

22

15

8

1

Saturday

30

23

16

9

2

Sunday

12

11

19

26

18

25

Columbus Day

5

4

Monday

June 2015
Tuesday

27

20

13

6

7

28

21

14

Wednesday

Thursday

29

22

15

8

1

Friday

30

23

16

9

2

31

24

17

10

3

Halloween

Saturday

18

11

4

28

Father’s Day

29

22

30

23

24

25

17

10

3

Thursday

21

16

9

2

Wednesday

Ramadan begins

Tuesday

Flag Day

15

14

1

8

Monday

7

First day of Summer

Sunday

October 2015
Friday

26

19

12

5

Saturday

27

20

13

6

Sunday

21

28

27

Rosh Hashanah

14

Labor Day

7

20

13

6

Monday

July 2015
Tuesday

29

22

15

8

1

9

2

30

First day of Fall

Yom Kippur

23

16

Wednesday

Thursday

24

17

10

3

Friday

25

18

11

4

Saturday

26

19

12

5

Sunday

6

13

20

27

5

12

19

26

Monday

Tuesday

September 2015

28

21

14

7

8

1

29

22

15

Wednesday

Thursday

30

23

16

9

2

Friday

31

24

17

10

3

4

25

18

11

Independence Day

Saturday

23

Sunday

31

17

16

30

10

9

24

3

2

Monday

August 2015
Tuesday

25

18

11

4

5

26

19

12

Wednesday

Thursday

27

20

13

6

Friday

28

21

14

7

Saturday

29

22

15

8

1


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