Attachment 12 – HC MEPS Monthly Planner

Attachment 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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2018 Monthly Planner

2018 Monthly Planner
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.
Use it to make notes about all types of
health care events:
	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
n

Also record other medical expenses:
	
n	
n	
n	
n

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

For each event, note:
	
n	
n	
n	
n

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

2017

January 2017

February 2017

Su

M

Tu

W

Th

F

Sa

1

2

3

4

5

6

7

8

9

10

11

12

13

14

5

6

15

16

17

18

19

20

21

12

22

23

24

25

26

27

28

29

30

31

July 2017
Su

M

Tu

Su

M

Tu

March 2017

W

Th

F

Sa

1

2

3

4

7

8

9

10

11

5

6

13

14

15

16

17

18

12

19

20

21

22

23

24

25

26

27

28

August 2017
W

Th

F

Sa

Su

M

1

Su

M

Tu

April 2017
W

Th

F

Sa

1

2

3

4

7

8

9

10

11

2

3

4

5

6

7

8

13

14

15

16

17

18

9

10

11

12

13

14

19

20

21

22

23

24

25

16

17

18

19

20

26

27

28

29

30

31

23
24
30

25

26

27

September 2017

Tu

W

Th

F

Sa

1

2

3

4

5

Su

M

Tu

W

Su

M

Tu

May 2017
W

Th

F

Sa

M

Tu

W

Th

F

Sa

1

2

3

4

5

6

7

8

9

10

11

12

13

4

5

6

15

14

15

16

17

18

19

20

11

12

21

22

21

22

23

24

25

26

27

18

28

29

28

29

30

31

25

1

October 2017
Th

Su

June 2017

November 2017

F

Sa

Su

M

Tu

W

Th

F

Sa

1

2

1

2

3

4

5

6

7

Su

M

Tu

Su

M

Tu

W

Th

F

Sa

1

2

3

7

8

9

10

13

14

15

16

17

19

20

21

22

23

24

26

27

28

29

30

Th

F

Sa

1

2

December 2017

W

Th

F

Sa

1

2

3

4

Su

M

Tu

W

2

3

4

5

6

7

8

6

7

8

9

10

11

12

3

4

5

6

7

8

9

8

9

10

11

12

13

14

5

6

7

8

9

10

11

3

4

5

6

7

8

9

9

10

11

12

13

14

15

13

14

15

16

17

18

19

10

11

12

13

14

15

16

15

16

17

18

19

20

21

12

13

14

15

16

17

18

10

11

12

13

14

15

16

16

17

18

19

20

21

22

20

21

22

23

24

25

26

17

18

19

20

21

22

23

22

23

24

25

26

27

28

19

20

21

22

23

24

25

17

18

19

20

21

22

23

23 24
25
30 31

26

27

28

29

27

28

29

30

31

24

25

26

27

28

29

30

29

30

31

26

27

28

29

30

24
25
31

26

27

28

29

30

W

Th

F

Sa

Su

M

Tu

W

Th

F

Sa

Tu

W

Th

F

Sa

W

Th

1

2

3

1

2

3

4

5

6

7

1

2

3

4

5

2018

January 2018
Su

February 2018

M

Tu

W

Th

F

Sa

1

2

3

4

5

6

7

8

9

10

11

12

13

4

5

6

14

15

16

17

18

19

20

11

12

21

22

23

24

25

26

27

18

28

29

30

31

25

July 2018

Su

M

2

3

7

8

9

10

4

5

6

7

8

9

10

8

9

10

11

12

13

14

6

7

8

9

10

11

12

3

4

5

6

13

14

15

16

17

11

12

13

14

15

16

17

15

16

17

18

19

20

21

13

14

15

16

17

18

19

10

11

12

19

20

21

22

23

24

18

19

20

21

22

23

24

22

23

24

25

26

27

28

20

21

22

23

24

25

26

17

18

26

27

28

25

26

27

28

29

30

31

29

30

27

28

29

30

31

24

25

Tu

W

Th

F

Sa

2

3

4

5

6

7

8

9

10

11

12

13

14

5

6

15

16

17

18

19

20

21

12

22

23

24

25

26

27

28

19

31

Su

26

M

September 2018
Th

F

Sa

1

2

3

4

7

8

9

10

11

2

3

4

5

6

7

8

13

14

15

16

17

18

9

10

11

12

13

14

20

21

22

23

24

25

16

17

18

19

20

21

28

29

30

31

Su

M

Tu

W

October 2018

W

27

Tu

Tu

Th

F

Sa

Su

25

26

27

28

M

November 2018

M

Tu

W

Th

F

Sa

1

2

3

4

5

6

7

8

9

10

11

12

13

4

5

6

15

14

15

16

17

18

19

20

11

12

22

21

22

23

24

25

26

27

18

19

1

23
24
30

Su

June 2018

1

M

M

May 2018

Sa

August 2018

Su

April 2018

F

1

30

W

March 2018
Th

Su

29

Tu

29

28

29

30

31

Su

25

M

26

Tu

M

Tu

F

Sa

1

2

7

8

9

13

14

15

16

19

20

21

22

23

26

27

28

29

30

Th

F

Sa

December 2018
Th

F

Sa

1

2

3

7

8

9

10

2

3

4

5

6

7

8

13

14

15

16

17

9

10

11

12

13

14

15

20

21

22

23

24

16

17

18

19

20

21

22

23 24
25
30 31

26

27

28

29

27

W

Su

28

29

30

Su

M

Tu

W

1

January 2018

Sunday

Monday

Tuesday

1

Wednesday

Thursday

Friday

Saturday

2

3

4

5

6

New Year’s Day

7

8

9

10

11

12

13

14

15

16

17

18

19

20

25

26

27

Martin Luther King, Jr. Day

21

22

23

24

28

29

30

31

February 2018

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Valentine’s Day

18

19

20

21

27

28

Presidents Day

25

26

Chinese New Year

22

23

24

March 2018

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Daylight Saving Time begins

18

St. Patrick’s Day

19

20

21

22

23

24

28

29

30

31

First day of Spring

25

26

27

Good Friday
First day of Passover

April 2018

Sunday

Monday

1

Tuesday

Wednesday

Thursday

Friday

Saturday

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Easter

Earth Day

29

30

May 2018

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

25

26

Mother’s Day

Ramadan begins

20

21

22

23

24

27

28

29

30

31

Memorial Day

June 2018

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

22

23

29

30

Flag Day

17

18

19

20

Father’s Day

24

21

First day of Summer

25

26

27

28

July 2018

Sunday

Monday

1

Tuesday

2

Wednesday

3

Thursday

4

Friday

Saturday

5

6

7

Independence Day

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

August 2018

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

September 2018

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

7

8

11

12

13

14

15

18

19

20

21

22

Labor Day

9

10

Rosh Hashanah

16

17

First day of Fall

Yom Kippur

23

24
30

25

26

27

28

29

October 2018

Sunday

Monday

7

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

8

9

10

11

12

13

Columbus Day

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

Halloween

November 2018

Sunday

Monday

4

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

5

6

7

8

9

10

12

13

14

15

16

17

19

20

21

22

23

24

Daylight Saving Time ends

11

Veterans Day

18

Thanksgiving

25

26

27

28

29

30

December 2018

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

7

8

First day of Hanukkah

9

10

11

12

13

14

15

16

17

18

19

20

21

22

First day of Winter

23

24
30

25
31

Christmas Day

26

First day of Kwanzaa

27

28

29

January 2019

Sunday

Monday

Tuesday

Wednesday

1

Thursday

Friday

Saturday

2

3

4

5

New Year’s Day

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

29

30

31

Martin Luther King, Jr. Day

27

28

February 2019

Sunday

Monday

3

Tuesday

4

Wednesday

5

Thursday

Friday

Saturday

1

2

6

7

8

9

13

14

15

16

22

23

Chinese New Year

10

11

12

Valentine’s Day

17

18

19

20

21

26

27

28

Presidents Day

24

25

March 2019

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

18

19

20

21

22

23

28

29

30

Daylight Saving Time begins

17

St. Patrick’s Day

24

First day of Spring

25
31

26

27

Important Dates

Phone Numbers

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Notes
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

2019

January 2019
Su

M

February 2019

Tu

W

Th

F

Sa

1

2

3

4

5

Su

M

Tu

W

March 2019
Th

F

Sa

1

2

Su

M

Tu

April 2019
W

Th

F

Sa

1

2

Su

May 2019

M

Tu

W

Th

F

Sa

1

2

3

4

5

6

Su

M

Tu

June 2019
W

Th

F

Sa

1

2

3

4

Su

M

Tu

W

Th

F

Sa
1

6

7

8

9

10

11

12

3

4

5

6

7

8

9

3

4

5

6

7

8

9

7

8

9

10

11

12

13

5

6

7

8

9

10

11

2

3

4

5

6

7

8

13

14

15

16

17

18

19

10

11

12

13

14

15

16

10

11

12

13

14

15

16

14

15

16

17

18

19

20

12

13

14

15

16

17

18

9

10

11

12

13

14

15

20

21

22

23

24

25

26

17

18

19

20

21

22

23

17

18

19

20

21

22

23

21

22

23

24

25

26

27

19

20

21

22

23

24

25

16

17

18

19

20

21

22

27

28

29

30

31

24

25

26

27

28

24
25
31

26

27

28

29

30

28

29

30

26

27

28

29

30

31

23
24
30

25

26

27

28

29

July 2019
Su

August 2019

M

Tu

W

Th

F

Sa

1

2

3

4

5

6

Su

M

Tu

7

8

9

10

11

12

13

4

5

6

14

15

16

17

18

19

20

11

12

21

22

23

24

25

26

27

18

28

29

30

31

25

September 2019
W

October 2019

Th

F

Sa

Su

M

Tu

W

Th

F

Sa

1

2

3

1

2

3

4

5

6

7

Su

7

8

9

10

8

9

10

11

12

13

14

6

13

14

15

16

17

15

16

17

18

19

20

21

19

20

21

22

23

24

22

23

24

25

26

27

28

26

27

28

29

30

31

29

30

M

November 2019

Tu

W

Th

F

Sa

1

2

3

4

5

Su

M

Tu

W

7

8

9

10

11

12

3

4

5

6

13

14

15

16

17

18

19

10

11

12

20

21

22

23

24

25

26

17

18

27

28

29

30

31

24

25

December 2019
Th

F

Sa

Su

M

Tu

W

Th

F

Sa

1

2

1

2

3

4

5

6

7

7

8

9

8

9

10

11

12

13

14

13

14

15

16

15

16

17

18

19

20

21

19

20

21

22

23

22

23

24

25

26

27

28

26

27

28

29

30

29

30

31

50308.0917

OMB #0935-0118
18-102


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