BIRTH____________Head Circ, HEP B #1
3-5 DAYS__________Head Circ, PHYSICAL ONLY, R of Milestones, Audio Screen
2 WEEKS__________Head Circ, NEW BORN SCREEN #2, R of Milestones, Audio Screen, EPDS (MOM)
2 MONTHS_________Head Circ, DTap1, IPV1, HEPB2, HIB1, PREV1, ROTA, Audio Screen, R of Milestones
4 MONTHS_________Head Circ, DTap2, IPV2, HIB2, PREV2, ROTA, Audio Screen, R of Milestones
6 MONTHS_________Head Circ, DTap3, IPV3, HEPB3, HIB3, PREV3, ROTA, Pb, Dental R, R of Milestones, Audio Screen, VISION
9 MONTHS_________Head Circ, PHYSICAL ONLY, ASQ, Audio Screen, Pb&Q, VISION, Dental R,
12 MONTHS________Head Circ, MMR, Varicella, HIB4, HEPA1, H&H, Pb&Q, TB Quest, Dental R, R of Milestones, Audio Screen, VISION
15 MONTHS________Head Circ, DTaP4, PREV4, Audio Screen, R of Milestones, Dental R
18 MONTHS________Head Circ, HEPA2, M-CHAT, Dental R, ASQ, Audio Screen
24 MONTHS________Head Circ, Pb, ASQ, M-CHAT, BMI%, TB Quest, Dental Referral, Audio Screen, VISION
30 MONTHS________R of Milestones, Audio Screen, Dental Referral, BMI%
3 YEARS___________PHYSICAL ONLY, ASQ, TB Quest, VISION, Pb, BP, Dental R, Audio Screen, BMI%
4 YEARS___________DTaP5, IPV4, MMR2, Varicella2, ASQ, TB Quest, VISION, AUDIO, Pb, BP, Dental BMI%
5 YEARS___________R of Milestones, VISION, AUDIO, TB Quest, BP, Dental R, BMI%
6 YEARS___________R of Milestones, VISION, AUDIO, TB Quest, BP, Dental R, BMI%
7 YEARS___________TB Quest, BP, Dental R, BMI%, Audio Screen (Provider), Vision
8 YEARS___________TB Quest, BP, VISION, AUDIO, Dental R, BMI%
9 YEARS___________HPV, Lipids, TB Quest, BP, Dental R, Audio Screen (Provider), Vision
10 YEARS__________HPV(Unless already administered), TB Quest, BP, VISION, AUDIO, Dental R, BMI%
11 YEARS__________HPV(Unless already administered), MCV, TDAP, TB Quest, BP, Dental R, BMI%, Audio Screen (Provider), VISION
12 YEARS__________HPV(Unless already administered), TB Quest, BP, BMI%, PHQ, Dental R, Vision, Audio Screen (Provider), VISION, Smoking Q
13 YEARS__________HPV(Unless already administered), TB Quest, BP, BMI%, Dental R, Audio Screen (Provider), VISION, PHQ, Smoking Q
14 YEARS__________HPV(Unless already administered), TB Quest, BP, BMI%, Dental R, Audio Screen (Provider), VISION, PHQ, Smoking Q
15 YEARS__________HPV(Unless already administered), TB Quest, BP, BMI%, Dental R, VISION, AUDIO, PHQ, Smoking Q
16 YEARS__________MCV, Trumenba, HIV, TB Quest, BP, BMI%, Dental R, Audio Screen (Provider), VISION, PHQ, Smoking Q
17 YEARS__________TB Quest, Trumenba? & HIV? (if not done at 16), BP, Dental R, BMI%, Audio Screen (Provider), VISION, PHQ, Smoking Q
18 YEARS__________TB Quest, Trumenba? & HIV? (if not done at 16 or 17), BP, Dental, Lipids, VISION, Audio Screen (Provider), PHQ, Smoking Q
***Any denial of an item on this list requires a signature from the parent stating why the denial and then scan the form into the patients chart.***