Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.
The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.
Health Assessment Screening, History, and Counseling
Ages 18 to 49 Years
One health maintenance exam (HME) every 1 to 5 years according to risk status [D]. Each HME should include:
- Height, weight, and body mass index (BMI)
- Risk Evaluation & Counseling (nutrition, overweight/obesity, physical activity, dental health, tobacco use [A], immunizations, human immunodeficiency virus (HIV) prevention [B], sexually transmitted diseases prevention [B] and sexual health, sexual abuse, preconception counseling for all women of reproductive age [B], polypharmacy including over-the-counter and herbal preparations when appropriate, sun exposure)
- Safety (domestic violence, seat belts [B], helmets, firearms, smoke and carbon monoxide detectors)
- Behavioral Assessment (depression, suicide threats, alcohol/drug use, anxiety, stress reduction, coping skills)
Blood Pressure Measurement [A]
Ages 18 to 49 Years
At every office visit and, at minimum, every 2 years. If blood pressure (BP) 120/80 or higher and/or presence of risk factors, more frequent monitoring is recommended.
Cholesterol and Lipid Screening [B]
Ages 18 to 49 Years
Measure a complete fasting lipoprotein profile (i.e., total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) every 5 years if initial test is normal in low-risk adults. If multiple risk factors are present, more frequent measurements are recommended.
Diabetes Mellitus Screening [C]
Ages 18 to 39 Years
No requirement unless high risk (e.g., family history of diabetes, obesity, hypertension, dyslipidemia, cardiovascular disease, African Americans, Native Americans, and Hispanics)
Ages 40 to 49 Years
Fasting plasma glucose (FPG) every 3 years (especially if BMI >25) and at clinical discretion. Regular screening over age 45.
Chlamydia Screening [B]
Ages 18 to 49 Years
Recommended for all sexually active women age 25 and younger, and sexually active women age 26 and older if high risk (i.e., new or multiple sexual partners, history of sexually transmitted diseases, not using condoms consistently or correctly)
Colorectal Cancer Screening [B] for Average Risk Adults
Ages 18 to 49 Years
No requirement unless high risk (e.g., family history, history of colorectal polyps, chronic inflammatory bowel disease)
Glaucoma Screening [C]
Ages 18 to 39 Years
No requirement unless high risk (e.g., increased intraocular pressure, family history, African Americans, people who have diabetes, myopia, regular/long-term steroid use, previous eye injury)
Ages 40 to 49 Years
Begin screening high risk patients annually at age 45
Cervical Cancer Screening [A] Pap Smear
Ages 18 to 49 Years
At least every 3 years, more frequently if high risk (i.e., history of abnormal Pap results, sexually transmitted diseases or HIV; sexual activity before age 18 or multiple partners; vaginal spotting or bleeding between periods, after intercourse or after menopause; tobacco use). (Consider discontinuation for patients with surgical removal of cervix for benign conditions).
Mammography [C]
Ages 18 to 39 Years
No requirement, unless high risk
Ages 40 to 49 Years
Every 1 to 2 years
Clinical Breast Exam [C]
Ages 18 to 39 Years
Every 3 years
Ages 40 to 49 Years
Every 1 to 2 Years
Immunizations
Tetanus Diphtheria Acellular Pertussis/Tetanus-diphtheria (TDaP/Td) [A]
Ages 18 to 49 Years
TDaP once after age 11, then Td every 10 years
Human Papilloma Virus (HPV)
Ages 18 to 39 Years
All females 26 years and younger should have full three vaccine series if not previously completed.
Influenza [B]
Ages 18 to 49 Years
Every year if high risk; optional for those who wish to avoid getting the flu
Definitions:
Levels of Evidence for the Most Significant Recommendation
- Randomized controlled trials
- Controlled trials, no randomization
- Observational studies
- Opinion of expert panel
