Worksheets

The following symbol lets you know that a link will open a helpful worksheet. Download these PDF worksheets to help you take control of your health care. In order to open PDF files, you must have the free software program Adobe Reader. If you have Adobe Acrobat or Adobe Professional, you will also be able to use these forms. (PDF stands for Portable Document Format.)

If you click on the PDF link and you get an error message, you may not have the Adobe Reader on your computer. Go to www.adobe.com to download the free Adobe Reader to your computer. Click the Get ADOBE READER link. You will be given directions on how to download the program.

Ask About Benefits
Trying to decide if a health plan is right for you? Use this form to evaluate the benefits of each plan you are considering.

Care for Children
Use this form to make sure your child gets the health care he or she needs.

Care for Adults 50+
This form helps you keep track of screening tests, preventive care, and common health conditions for older adults. Use it to help you discuss these topics with your doctor at your next visit.

Care for Men
This form helps you keep track of screening tests, preventive care, and common health conditions for men that you may need to discuss with your doctor. Use it to help you prepare for your next visit.

Care for Women
This form helps you keep track of screening tests, preventive care, and common health conditions for women that you may need to discuss with your doctor. Use it to help you prepare for your next visit.

Choose a Doctor
Do you need to find a new doctor? Use this worksheet to help find a doctor who meets your needs.

Communication Assistance If You Have a Disability
Share this worksheet with your doctor's office so they know how you want to communicate.

Compare HMO Costs
Use this form to compare costs for each HMO you are considering.

Compare PPO Costs
Use this form to compare costs for each PPO you are considering.

Make the Most of Doctor Visits
Use this worksheet to help prepare for your doctor visits.

My Complaint
If you have a complaint, use this worksheet to keep track of details, such as dates, the people you talked to, decisions made, and next steps.

My Health History
Use this form to keep a record of your health care, past conditions, and family health history. Bring it with you when you go to a new doctor.

My HMO Costs
Fill out this worksheet to estimate your out-of-pocket expenses if you are in an HMO.

My PPO Costs
Fill out this worksheet to estimate your out-of-pocket expenses if you are in a PPO.

My Medicines
Use this worksheet to list all the medications that you are taking. Share this with your doctor and keep a copy in your wallet.

Prenatal Care
This worksheet can help you keep track of care you need and things to ask at every stage of your pregnancy.

Physical Access If You Have a Disability
Share this worksheet with your doctor's office so they know what physical accommodations you need during your visit.

Prepare for a Hospital Stay
Are you unsure of what to expect when you go to the hospital? This worksheet will help you prepare.

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