EPSDT/Well Child Exam
Health Maintenance Examination (HME) Forms
0-4 Weeks
0-4 Weeks (PDF)
9 months
9 months (PDF)
3 year
3 year (PDF)
6-10 year
6-10 year (PDF)
2 Months
2 months (PDF)
12 months
12 months (PDF)
4 year
4 year (PDF)
11-14 year
11-14 year (PDF)
4 months
4 months (PDF)
15-18 months
15-18 months (PDF)
5 year
5 year (PDF)
15-20 year
15-20 year (PDF)
6 months
6 months (PDF)
2 year
2 year (PDF)
Child IAC Immunization Schedule (PDF)
Spanish language parent information sheets (for use with above HME forms).
Arabic language parent information sheets for use with above HME forms (in PDF format).
Reference Sheet
Childhood Immunization Schedule
Arabic Language Sheets to accompany HME forms:
Periodicity Table
Social, Emotional, and Developmental Health
Immunization
Tools
Well Child and Immunization Codes
(In MS Excel. Includes well
child codes and immunization
codes on
separate tabs.)
EarlyON Information Sheet
Head Start Information Sheet
Social-Emotional Development in Young Children Guide
Medicaid Behavioral & Mental Health Benefits
General Information
Immunization Schedule from CDC Web Site
Child IAC Immunization Schedule
MDCH Clearinghouse Resources
Web-based Lead Risk Screening Tool
"Make your Immunizations Count" Information Sheet
(HEDIS codes)
AIM Vaccine Administration Record for Children and Teens
Current Vaccine Information Sheets
Reminder Labels
Instructions for the Use of Vaccine Information Statements (PDF)
Injectable Vaccine Administration for Children Birth-6 years (PDF)
Injectable Vaccines for Selected Populations (PDF)
Alliance for Immunization in Michigan (AIM) Toolkit Website
Toolkit Order Form order item "IM106"
