Health Maintenance Visit |
Annually for all ages. Includes initial/interval history, age-appropriate physical exam; height and weight measurements; preventive screenings and counseling; assessment and administration of needed immunizations. |
Oral Health Visit |
Promote dental health through regular oral hygiene practices, assessment by a dentist at least every 6 months, and timely management of dental disease. |
Labs and Screenings |
Cancer Screening |
Breast Cancer: Mammography |
Clinical breast exam as appropriate. Mammography not routine except for patients at high risk. Accurate and detailed history and family history will identify risk factors. |
Clinical breast exam as appropriate. Annual mammography at discretion of clinician/patient. |
Clinical breast exam as appropriate. Annual mammography. |
Mammography annually through age 69. Age 70+ at discretion of clinician/patient. |
Cervical Cancer (Pelvic Exam & Pap Smear) |
First pap smear by age 21. Every 1-3 years, at clinician/patient's discretion. |
May be omitted after age 65 if previous screenings were consistently normal. |
Colorectal Cancer |
Not routine except for patients at high risk. |
Starting at age 50, fecal occult blood testing (FOBT) and sigmoidoscopy every 5 years OR annual FOBT OR colonoscopy every 10 years. Screening after age 80 at clinician/patient discretion. |
Testicular and Prostate Cancer |
Prostate cancer screening not routine. Clinical testicular exam at clinician's discretion. |
Digital rectal exam (DRE) for patients with risk factors for prostate cancer: family history & African-American ancestry. Prostate specific antigen (PSA) screening in high-risk patients at clinician/patient discretion. |
DRE. Discuss risks and benefits of PSA blood test with patients starting at age 50. Offer PSA at clinician/patient's discretion. |
Skin Cancer |
Periodic total skin examinations every 3 years between the ages of 20 and 39 and annually at age 40 and older, regardless of skin tone and color. Frequency at clinician discretion based on risk factors. |
Other Recommended Screening |
Body Mass Index (BMI) |
Screen for overweight and eating disorders. Consult the Centers for Disease Control and Prevention's (CDC's) growth and BMI charts (www.cdc.gov/nccdphp/dnpa/bmi/index.htm). Ask about body image and diet patterns. Counsel on benefits of physical activity and a healthy diet to maintain desirable weight for height. Offer more focused evaluation and intensive counseling for adults for BMI >30 kg/m2 to promote sustained weight loss. |
Hypertension |
At every acute/non-acute medical encounter and at least annually. |
Cholesterol |
Every five years or at clinician's discretion. |
At clinician's discretion. |
Diabetes (Type 2) |
At least every 5 years until age 45. Every 3 years after age 45. Fasting plasma glucose screen for individuals at high risk. Risk factors include: family history of premature coronary heart disease (CHD), hypertension, overweight, diabetes mellitus, peripheral atherosclerosis or carotid artery disease, current cigarette smoking, or high-density lipoprotein (HDL) <35 mg/dL. |
Liver Function |
Annually for hepatitis B carriers. At clinician's discretion after consideration of risk factors including long term prescription medication.
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Dysphagia & Aspiration |
Chronic dysphagia and gastroesophageal reflux disease (GERD) are common in individuals with developmental disabilities (DD) and neuromuscular dysfunction. Screen initially and inquire about changes at annual physical. |
Cardiovascular Disease |
Screen for cardiovascular diseases and malformations earlier and more regularly than the general population. Specific syndromes and neuroleptic medications may increase risk for cardiac disease. |
Osteoporosis |
Bone density screening (BMD) starting at age 19 when risk factors are present: long term polypharmacy, mobility impairments, hypothyroid, post-menopausal women. Periodicity of screening at clinician's discretion. Annually counsel about preventive measures including dietary calcium and vitamin D intake, weight-bearing exercise, and smoking cessation. |
Provide BMD testing. Counsel elderly patients about specific measures to prevent falls. |
Infectious Disease Screening |
Sexually Transmitted Infections |
For chlamydia and gonorrhea: Sexually active patients under age 25: Screen annually. Patients age 25 and over: Screen annually, if at risk. Screen pregnant women at the first prenatal visit and in the third trimester, for all sexually transmitted infections (STIs) if at risk. |
Human Immunodeficiency Virus (HIV) |
Periodic testing if at risk and testing of pregnant women at increased risk. |
Hepatitis B and C |
Periodic testing if risk factors present. |
Tuberculosis (TB) |
Tuberculin skin testing ever 1-2 years when risk factors present. Risk factors include residents or employees of congregate setting, close contact with persons known or suspected to have TB. |
Sensory Screening |
Hearing Assessment |
Screen annually. Re-evaluate if hearing problem is reported or a change in behavior is noted. |
Vision Assessment |
Screen annually. Re-evaluate if vision problems are reported or change in behavior is noted. |
Eye Exam for Glaucoma |
Every 3-5 years in high risk patients. At least once in patients with no risk factors. |
Every 2-4 years |
Every 2-4 years |
Every 1-2 years |
Mental and Behavioral Health |
Depression |
Screen annually for sleep, appetite disturbance, weight loss, general agitation. |
Dementia |
Monitor for problems performing daily activities. |
In persons with Down Syndrome, annual screen after age 40. |
Immunizations |
Influenza |
Annually |
Annually |
Annually |
Annually |
Annually |
Pneumococcal |
Once, especially if at elevated risk. Once after 65 years of age, even if vaccinated before 65 years of age. |
Hepatitis B |
Once. Reevaluate antibody status every 5 years. |
Hepatitis A |
If at high risk and not previously immunized. |
Tetanus, Diphtheria, Pertussis (TdaP) |
3 doses if not previously immunized. Booster every 10 years. |
Measles, Mumps, and Rubella (MMR) |
If born after 1956 and have not been immunized or have laboratory evidence of immunity. Receive a second dose of measles-containing vaccine if at risk. Ages 50+: Not routine. |
Human Papillomavirus (HPV) Vaccine** |
Three injections given over a 6-month period to females up to 26 years old. |
Varicella (Chicken Pox) |
2 doses recommended for those who do not have documentation of age-appropriate immunization or a reliable history of chicken pox (varicella). |
Zoster (shingles) Vaccine** |
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Once after age 60, not for those with weak immune systems. |
For Persons with Down Syndrome (in addition to the above recommendations) |
Thyroid Function Test |
Every 3 years (sensitive thyroid stimulating hormone [TSH]). |
Cervical Spine X-ray to Rule Out Atlanto-axial Instability |
Obtain baseline as adult. Recommend repeat if symptomatic, or 30 years from baseline. |
Echocardiogram |
Obtain baseline if no records of cardiac function are available. |
General Counseling and Guidance |
Prevention Counseling |
Annually counsel regarding prevention of accidents related to falls, fire/burns, choking and screen for at-risk sexual behavior. |
Abuse or Neglect |
Annually monitor for behavioral signs of abuse and neglect. |
Preconception Counseling |
As appropriate, including genetic counseling, folic acid supplementation, discussion of parenting capability. |
Menopause Management |
At an appropriate age, counsel women on the changes that occur at menopause and their options for the symptom management. |
Healthy Lifestyle |
Annually counsel regarding diet/nutrition, incorporating regular physical activity into daily routines, substance abuse. |