ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
Use Smart Shopper to search for and all medical procedures to see if reimbursement possible
2
 MomDadChildChild
3
Physician (Adult)(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)		(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)
4
Appointment Date(Last Appt.: ) (Next Appt.: )(Last Appt.: ) (Next Appt.: )
5
Address Current/Updated?
6
Pediatrician (Kid) (Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)		(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)
7
Appointment Date(Last Appt.: ) (Next Appt.: )(Last Appt.: ) (Next Appt.: )
8
Address Current/Updated?
9
Gynecologist (Woman) (Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)
10
Appointment Date(Last Appt.: ) (Next Appt.: )
11
Address Current/Updated?
12
Dentist (Teeth)(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)		(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)		(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)		(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)
13
Appointment Date(Last Appt.: ) (Next Appt.: )(Last Appt.: ) (Next Appt.: )(Last Appt.: ) (Next Appt.: )(Last Appt.: ) (Next Appt.: )
14
Address Current/Updated?
15
Optical (Eye)(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)		(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)		(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)		(Doctor's Name)
(Street Addresss)
(City, State, Zipcode)
(Phone Number)
16
Appointment Date(Last Appt.: ) (Next Appt.: )(Last Appt.: ) (Next Appt.: )(Last Appt.: ) (Next Appt.: )(Last Appt.: ) (Next Appt.: )
17
Address Current/Updated?
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100