Do not enter names, birth dates, addresses, Medicare numbers, diagnoses, account details, or full medical histories. Keep provider records and eligibility documents in a secure private location.

This planner uses CMS eligibility information current in July 2026. GUIDE is voluntary, a GUIDE care team and CMS confirm eligibility, and program rules or service areas may change. Do not change Medicare coverage, hospice care, housing, or a care plan based on this worksheet.

Official references: CMS GUIDE Model overview and participant list, CMS GUIDE eligibility FAQ, CMS patient and caregiver fact sheet, Eldercare Locator.