Wellness physical exam forms
[DOC File]History and Physical Exam Form
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Physical Health Exam Periodically Cholesterol Screening Every 5 years. Men beginning at age 35, Women at age 45. Pap Smear (F) Every 1-3 years to age 65 Mammogram (F) Every 1-2 years, over age 49 Breast exam (F) Every 1-2 years PSA (M) At clinician's discretion Sigmoidoscopy Every 3-5 years after age 19 Glaucoma Blacks - ages 20-45 every 3-5 ...
[DOT File]Office of Children and Family Services | Home | OCFS
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Summary of Physical Exam. Include special recommendations to child day care providers. On the basis of my findings as indicated above and on my knowledge of the named child, I find that: he/she is free from contagious and communicable disease and is …
[DOC File]American College of Physicians | Internal Medicine | ACP
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Annual Wellness Visit, Subsequent Once a year (more than 1 yr + 1 day after the last Wellness Visit). The Annual Wellness Visit is not the same thing as what many people often refer to as their yearly physical exam. Medicare is very specific about what the “Annual Wellness …
[DOC File]School Dental Form - Department of Health Home
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1ST EXAM Yes No 2ND EXAM Yes No 3RD EXAM Yes No 4TH EXAM Yes No 5TH EXAM. Yes No OTHER. Yes No NAME OF STUDENT _____ DENTAL FINDINGS – Check Applicable Items. Grade Date EXAMINED OR EVALUATED BY Prophylaxis SPECIAL PROJECTS (Specify) FLUORIDE Oral Evaluation. Passed/ Referred TOTALS ...
[DOC File]CHIROPRACTIC REGISTRATION AND HEALTH ... - Wellness First
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( ) wellness- promotion of optimal functioning of all bodily systems ( ) other: _____ Show Area(s) of Pain or Unusual Feeling. Mark the areas on this body where you feel the described sensations. Use the appropriate symbols. Mark areas of radiation. Include all affected areas.
[DOC File]HEAD START: CHILD HEALTH RECORD: EPSDT / SCREENINGS ...
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Date of Exam: _____ SCREENING TESTS: All items are required by Head Start and recommended by the American Academy of Pediatrics for age one month through 4 year well child visits. At a minimum check appropriate boxes in RESULTS/DATE column and complete highlighted areas. Enter date if done previously.
[DOC File]KLA Healthcare Consultants
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Medicare Well Patient Physical. Type of . Wellness Exam: ___IPPE – Welcome to Medicare – Select G0402, G0403, G0404 or G0405 (1 time during first 12 months on Medicare) ___Initial AWV w/PPPS – G0438 (1 time only after 1st 12 months of …
IMPERIAL CENTER FAMILY MEDICINE
Wellness Physical Exam. Frequently, medical issues arise during the yearly Wellness Physical Exam. We understand that it is difficult for patients to fit office visits into their busy schedules, so we try to address medical issues (unrelated to Wellness Physical Exam) at the time of the visit when time allows.
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