Immunization & Physical Exam Schedule

BIRTH Head Circ (FOC), HEP B #1;
3-5 DAYS SDoH, EPDS (MOM), Head Circ (FOC), PHYSICAL ONLY, R of Milestones, Audio Screen
2 WEEKS SDoH, EPDS (MOM), Head Circ (FOC), NEWBORN SCREEN #2, R of Milestones, Audio Screen,
2 MONTH SDoH, Head Circ (FOC), DTap1, IPV1, HEPB2, HIB1, PREV1, ROTA, Audio Screen, R of Milestones
4 MONTH SDoH, Head Circ (FOC), DTap2, IPV2, HIB2, PREV2, ROTA, Audio Screen, R of Milestones
6 MONTH SDoH, Pb Q, Head Circ (FOC), VISION, DTap3, IPV3, HEPB3, HIB3, PREV3, ROTA, Dental R, R of Mile, Audio S
9 MONTH ASQ, SDoH, Head Circ (FOC), Pb Q, PHYSICAL ONLY, Audio & Vision Screen, Dental R
12 MONTH SDoH, Head Circ (FOC), Pb&Q, TB Quest, VISION, MMR, Varicella, HIB4, HEPA1, H&H, Dental R, R of Mile, Audio S
15 MONTH SDoH, Head Circ (FOC), Pb Q, DTaP4, PREV4, Audio Screen, R of Milestones, Dental R,
18 MONTH SDoH, ASQ, M-CHAT, Head Circ (FOC), Pb Q, HEPA2, Dental R, Audio Screen
24 MONTH SDoH, ASQ, M-CHAT, Head Circ (FOC), Pb & Q, BMI%, TB Quest, VISION, Dental R, Audio Screen
30 MONTH SDoH, BMI%, R of Milestones, Audio Screen, Dental R
3 YEARS SDoH, ASQ, BMI%, Pb Q, TB Quest, VISION, AUDIO, BP, PHYSICAL ONLY, Dental R, Audio Screen
4 YEARS SDoH, ASQ, TB Quest, BP, BMI%, DTaP5, IPV4, MMR2, Varicella2, Dental R
5 YEARS SDoH, VISION, AUDIO, TB Quest, BP, BMI%, R of Milestones, Dental R
6 YEARS SDoH, VISION, AUDIO, TB Quest, BP, BMI%, R of Milestones, Dental R
7 YEARS SDoH, TB Quest, BP, Vision, BMI%, Audio Screen (Provider) Dental R
8 YEARS SDoH, TB Quest, BMI%, BP, VISION, AUDIO, Dental R
9 YEARS SDoH, TB Quest, BP, Vision, HPV, Lipid, Dental R, Audio Screen (Provider),
10 YEARS SDoH, BP, VISION, AUDIO, TB Quest, BMI%, HPV, Dental R
11YEARS SDoH, VISION, TB Quest, BP, BMI%, MCV, TDAP, HPV, Dental R, Audio Screen (Provider)
12 YEARS SDoH, PHQ, BP, BMI%, VISION, Smoking Q, TB Quest, HPV, Dental R, Audio Screen (Provider) ,
13 YEARS SDoH, PHQ, TB Quest, BP, BMI%, VISION, Smoking Q, HPV, Dental R, Audio Screen (Provider)
14 YEARS SDoH, PHQ, TB Quest, BP, BMI%, Smoking Q, VISION, HPV, Dental R, Audio Screen (Provider),
15 YEARS SDoH, PHQ, TB Quest, BP, BMI%, VISION, AUDIO, Smoking Q HPV, Dental R
16 YEARS SDoH, PHQ, TB Quest, BP, BMI%, VISION, Smoking Q, MCV, Bexsero (6mths apart), HIV, Dental R, Audio S (Pro),
17 YEARS SDoH, PHQ, TB Quest, BP, BMI%, VISION, Smoking Q, Bexsero?, HIV?(if not done at 16), Dental R, Audio S (Pro),
18 YEARS SDoH, PHQ, TB Quest, BP, VISION, Bexsero?, HIV? (if not done at 16/17), Lipid, Dental R, Audio Screen (Pro)

**Any refusal of an item on this list requires a signature from the parent stating why the refusal and then scanning the form into the patient’s chart.**