SMP Hawaii Counseling Report
Please record all counseling interactions that take place during the current month. Counseling interactions are conversations that last longer than 15 Minutes and are more involved than individual interactions.
Month of: *
Your answer
Team Member Name *
Your answer
Date: *
MM
/
DD
/
YYYY
How many different individuals did you speak with during the month?
Your answer
Your Zip Code *
Your answer
Record the total cumulative time spent throughout the month speaking on the SMP-related topics below:
Remember, COUNSELING interactions last longer than 15 minutes and are more involved than INDIVIDUAL interactions. If your conversation was less that 15 minutes, use the Individual Interaction Form instead. You may submit more than one Counseling Report during the month if needed, but a single form with cumulative totals is preferred.
Consumer Protection
Your answer
Durable Medical Equipment (DME)
Your answer
Employer Health Plan
Your answer
General Fraud, Errors, and Abuse
Your answer
Home Health Care
Your answer
Hospice
Your answer
Medicaid
Your answer
Medical Identity Theft
Your answer
Medicare Advantage
Your answer
Medicare Part A and B
Your answer
Medicare Part D
Your answer
Medigap or Supplemental Insurance
Your answer
New Medicare Cards ( Without SSNs)
Your answer
SMP Program Information
Your answer
SMP Volunteer Recruitment
Your answer
Social Security
Your answer
TRICARE
Your answer
Veterans Health Benefits (VA)
Your answer
Other
Your answer
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