Managed Care Quality Improvement and Accreditation
EPSDT/Well Child Exam
Health Maintenance Examination (HME) Forms
NOTE: HME forms are now updated to correspond with the current AAP/Bright Futures guidelines. Please refer to the periodicity table link below.
0-1 Week
0-1 Week (PDF)
9 Months
9 Months (PDF)
30 Months
30 Months (PDF)
6-10 Year
6-10 Year (PDF)
4 Weeks
4 Weeks (PDF)
12 Months
12 Months (PDF)
3 Year
3 Year (PDF)
11-14 Year
11-14 Year (PDF)
2 Months
2 months (PDF)
15 Months
15 Months (PDF)
4 Year
4 Year (PDF)
15-20 Year
15-20 Year (PDF)
4 Months
4 Months (PDF)
18 Months
18 Months (PDF)
5 Year
5 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:
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
AIM Vaccine Administration Record for Children
Current Vaccine Information Statements
Reminder Labels
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)
To request a heard copy of the AIM Toolkit please go to MDCH Health Promotions Clearinghouse. Click on "Immunizations" and order item "IM 106."
