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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)

Spanish language parent information sheets (for use with above HME forms).

0-4 Weeks 9 months 3 year 6-10 year
2 months 12 months 4 year 10-14 year
4 months 18 months 5 year 14-20 year
6 months 2 year 6 year  

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:

0-4 Weeks 12 months 4 year
2 months 15-18 months 5 year
4 months 2 year 6 year
6 months 3 year  
AAP/Bright Futures Periodicity Table
Reminder Postcard for Parents
(designed for Avery Laser Index and Postcard 5389)
EPSDT brochure for Parents
EPSDT Brochure for Providers
Billing Codes

Social, Emotional, and Developmental Health

Immunization

Tools
Resources
Women, Infants, & Children (WIC)

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

Michigan WIC Program Guidelines
Screening Questionnaire for Children and Teens (PDF) Resource Directory WIC Booklet
"Make your Immunizations Count" Information Sheet (HEDIS codes) Links to immunization and Lead Pamphlets and other MDCH brochures WIC Booklet Insert
 

AIM Vaccine Administration Record for Children

Current Vaccine Information Statements

Reminder Labels

 

Use of Vaccine Information Statements  (PDF)

 
Summary of Recommendations for Childhood and Adolescent Immunization (PDF)

Injectable Vaccine Administration for Children Birth - 6 years (PDF)

Injectable Vaccines for Selected Populations (PDF)

After the Shots (PDF)

Alliance for Immunization in Michigan (AIM)

To request a heard copy of the AIM Toolkit please go to MDCH Health Promotions Clearinghouse.  Click on "Immunizations" and order item "IM 106."