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Michigan State UniversityInstitute for Health Policy Institute for Health Policy

triangleEPSDT Clinician Toolkit

EPSDT/Well Child Exam

For questions or more information please contact Suzette Burkitt-Wesolek at 517-432-1701.

NOTE: Well Child Exam Forms (Updated 4/2011) correspond with the current AAP/Bright Futures guidelines. Please refer to the periodicity table link below.

The Well Child Exam forms consist of four pages. The first page is the physical exam; the second page is Developmental Surveillance and may be used if a Validated Developmental Screener is not used; the third page is required for foster care children; and the fourth page is a parent information handout.

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)

15-18 Year
15-18 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)

 


Spanish language parent information sheets for use with above Well Child Exam forms. Last updated in 2011.

0-4 Weeks

9 months

3 year

6-10 year

2 months

12 months

4 year

11-14 year

4 months

18 months

5 year

15-18 year

6 months

2 year

 

 


Arabic language parent information sheets for use with above Well Child Exam forms (in PDF format). Last updated in 2011.

0-4 Weeks

12 months

4 year

2 months

15-18 months

5 year

4 months

2 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

Billing Codes

Social, Emotional, and Developmental Health

Immunization Websites

Resources

Women, Infants, & Children (WIC)