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, obesity, physical activity, dental health, tobacco use [A], immunizations, human immunodeficiency virus (HIV) prevention [B], sexually transmitted infections 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 Monitoring [A]
Ages 18 to 49 Years
At every office visit and, at minimum, every 2 years. If blood pressure (BP) 120-139/80-89 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]) in men 35 years and older and women 45 years and older without other risk factors. Screen younger adults for lipid disorders if other risk factors for coronary heart disease (CHD) (i.e., diabetes, family history of cardiovascular disease before age 50 in male relatives or age 60 in female relatives), multiple CHD risk factors (e.g., tobacco use, hypertension). Once screening begins, repeat every 5 years for low risk adults if initial test normal; consider more frequent screening in individuals at increased risk.
Diabetes Mellitus Screening [D]
Ages 18 to 39 Years
Screening may be indicated in patients with risk factors for diabetes (e.g., obesity, family history, high-risk ethnic groups [African Americans, Native Americans, Hispanics and Pacific Islanders], previously identified impaired fasting plasma glucose [FPG] or impaired glucose tolerance; history of gestational diabetes, hypertension, HDL-C < 35 mg/dL and/or triglyceride > 250 mg/dL, polycystic ovarian disease, or history of vascular disease)
Ages 40 to 49 Years
FPG every 3 years (especially if BMI >25) starting at age 45.
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).
Chlamydia Screening [B]
Ages 18 to 49 Years
Recommended for all sexually active women age 24 and younger, and sexually active women age 25 and older if high risk (i.e., new or multiple sexual partners, history of sexually transmitted diseases, not using condoms consistently or correctly).
Mammography with or without Clinical Breast Examination [C]
Ages 18 to 39 Years
No requirement, unless high risk
Ages 40 to 49 Years
Every 1 to 2 years
Immunizations
(Consult Advisory Committee on Immunization Practices (ACIP) website, www.cdc.gov/vaccines/recs/acip/ for up-to-date recommendations)
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 Papillomavirus (HPV) [D]
Ages 18 to 39 Years
All females 26 years and younger should have full three vaccine series if not previously completed.
Measles, Mumps, Rubella (MMR) [C], Varicella [C]
Ages 18 to 49 Years
MMR 2 doses; varicella as indicated by ACIP guidelines
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
