The Ambulatory and Home Care Record: A Methodological Framework for Economic Analyses in End-of-Life Care

Table 6

Name of medicine or description of equipment/supplies (e.g., syringes, thermometer)	Amount paid by you		Provided by home care agency. If equipment, borrowed or given to you to keep?
	Total cost of medicine (including dispensing fee) or supplies/equipment (rented/purchased)	Will you be reimbursed for this money? (yes or no); If yes, indicate % or amount reimbursed
Acetaminophen	$10	No	No
Nutritional Drinks	$13	Yes (90%)	No