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Adolescent and Child Health Maintenance Forms

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A series of health maintenance forms that cover adolescents and children from 1 week to 18 years.

MEDICARE PREVENTIVE PHYSICAL EXAM

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“As of January 1, 2012, the Centers for Medicare & Medicaid Services (CMS) requires that a health risk assessment (HRA) be completed as part of the Medicare annual wellness visit. Efforts by the AAFP and others to persuade CMS to delay the HRA were unsuccessful, and the requirement became effective without a compliant form for physicians to use.” “To fill this void, the AAFP's practice improvement journal Family Practice Management (FPM) published a questionnaire developed by HowsYourHealth.org.

Pediatric Health Maintenance Form

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Pediatric health maintenance checklist, 2 weeks to 6 years.

Prenatal Care

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Appointment for first visit should be scheduled within 8 weeks of gestation. The first appointment is scheduled with perinatal nurse.
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