SCREENING EXAMINATIONS / Mammography, Females, 40 to 85 years or as long as in good health
- Yearly
Colorectal Cancer Screening, Males & Females, 50 to 75 years
- Colonoscopy, screening, every 10 years or
- Barium enema, within 10 years or
- Flexible sigmoidoscopy, 5 years or
- Hemoccult, yearly
Pelvic examination with PAP
- 21 to 65 years, every 3 years, pap only or
- 30 to 65 years , every 5 years, pap and HPV culture
Chlamydia screening, 18 to 24 years
- Annually with onset of sexual activity
- Only one time
- Family history of abdominal aortic aneurysm
- Smoked at least 100 cigarettes in his lifetime
LABORATORY TESTING / Fasting Lipid profile, Males > 34 to 75 years and females > 44 to 75 years; every five years
Fasting Glucose level, > 18 years ; every 5 years
Source: US Preventive Services Task Force; 9/16/02
IMMUNIZATIONS / HPV, males and females- 19 to 26 years, 3 injection series
Source: APIC/ MMWR 12/23/11
Influenza Vaccine,18 years and older, yearly,
Source: ACIP, 07/31/09
TDaP once for 19 to 64 years if exposed to children under 2 years of age, or Td boosterevery 10 years
Source: ACIP/MMWR, 01/14/11
Pneumococcal vaccine, 1 x dose at 65, earlier if high risk.
Revaccinate if the patient is 65 years old and if the 1stdose was given at < 65 years and greater than 5 years ago.
Source: ACIP, 04/04/97
SELF MANAGEMENT GOAL SETTING & SUPPORT / Discuss goal setting and support needs
Smoking status assessed, all 18 years of age, yearly
Smoking cessation advised, all 18 years of age, yearly
Source: U.S. Preventive Services Task Force; 9/16/02
REFERRALS / Smoking Cessation- the Quit Line , CHER classes
OTHER / Provide Rockwood approved adult health maintenance material, as needed
Provider Signature ______Date______
9/25/2018