PERSONAL HEALTH EXPENSES
2. In entering the medical expenditures in questions 1 through 3, count all bills paid (or to be paid) by the person himself, his family or friends. Also include any part paid by insurance, whether paid directly to the hospital or doctor or paid to the person himself, or to his family. If you do not know exactly the amount paid by insurance, estimate it, and include it in the total bill.
3. In figuring the total doctor, hospital , or dentist bills, do not count any amounts paid (or to be paid) by:
Non-profit organizations such as the "Polio foundation"
Charitable or Welfare organizations
Federal, State, City or County government
4. If there are any babies in the household who were born during the past 12 months, the hospital and doctor bills relating to the baby's birth should be reported on the page for the mother. All other meidcal expenditures relating to the baby's health should be reported on the page for the baby.
Immunizations or shots
Any other doctor's services
 No doctors' bills
 No (go to question 3)
Room and board
Operating and delivery room
Any other hospital services
Straightening of teeth
Any other dental services
 No dentists' bills
Do not count: 1. Visits to dentists. 2. Any visits made to this person while he was an inpatient for one or more nights in a hospital. (However, please note that the bills for such visits should be included in question 1 above).