Preventive Health Care Guidelines Summary

• Daily multivitamins with folic acid for all women planning pregnancy
• Hepatitis B and rubella titers
• Screening for bacteriuria 12–16 weeks
• ABO and D (formerly Rh) blood typing and antibody testing for all pregnant women at first prenatal visit and for all unsensitized D-negative women at 24–28 weeks, unless biological father is known to be D-negative
• Diabetes screening at 28 weeks
• Screening for metabolic errors for all newborns prior to discharge from nursery
• HIV screening for all pregnant women

• General physical exam, extent determined by physician, performed at months: 1, 2, 4, 6, 9, 12, 15, 18 and 24
• Immunizations: Following is a summary — specific recommendations may vary depending on vaccine type and whether "catch-up" doses are needed.

• General physical exam, extent determined by physician, performed at years: 2, 3, 4, 5, 6, 10, 12, 14, 16 and 18
• Age appropriate health counseling covering tobacco use, sexual behavior, dental care, diet, nutrition, substance abuse, stress management, exercise, and injury prevention
• Testing for syphilis, gonorrhea and chlamydia, as necessary for those at risk for sexually transmitted diseases
• Pap smear/bi-manual pelvic exam annually for females who are or have been sexually active
• Fasting glucose beginning at age 10 for overweight and 2 risk factors

• History and physical examination every two years, including blood pressure measurement
• Bimanual pelvic exam (female only) every 1–3 years based on risk factors
• Testicular exam every two years age 18 years (male only)
• Digital rectal exam annually over age 50 at physician discretion
• Clinical breast exam annually over age 40 (female only)
• Diagnostic testing, which includes
  • cholesterol every five years
  • fasting glucose every 3 years, age 45 and above
  • screening mammography, every one-to-two years age 40–49, then yearly age 50 and over (female only)
  • pap smear every 1-3 years based on risk factors (female only)
  • stool blood test annually over age 50
  • PSA annually age 50 and older (male only)
• Endoscopy for colorectal cancer screening every 5–10 years beginning at age 50
• Immunizations
  • Tetanus, diphtheria, pertussis — 1 dose Td booster every 10 years, substitute 1 dose Tdap
  • Human papilloma virus — 3 dose HPV for females (not previously immunized) through age 26
  • Influenza vaccine yearly age 50 and above
  • Pneumonia vaccine — 1 dose age 65 and above
  • Varicella — 2 dose if no history of disease
  • Zoster — 1 dose age 60 and above

Note: referral to specialist is appropriate for these high-risk patients.

• HIV test, annually or periodically for
  • Male with male sex partner
  • IV drug use or history of IV drug use
  • Male or female prostitute or multiple sex partners
  • HIV positive partner
• TB skin test (PPD) annually if
  • TB case exposure in the home
  • Recent immigrant from country with high TB incidence
  • HIV positive, chronic renal failure or immunosuppressed condition
• Syphilis, gonorrhea or chlamydia tests as necessary for those at risk for sexually transmitted diseases
• Influenza vaccine annually for:
  • Residents of chronic care facilities
  • Sufferers from chronic heart/lung diseases, metabolic diseases, hemoglobinopathies, immuno-suppression, kidney failure or chronic liver disease
  • Health care providers
  • Children and adolescents on long-term ASA therapy
  • Pregnant women
  • Age 6 months – 59 months
  • Age 50 and older
• Screening endoscopy for high-risk patients
  • Hereditary colon polyps
  • Ulcerative colitis
  • Colon polyps
  • Prior colon cancer
  • History of first degree relative with colon cancer
• PSA annually age 40 and older for high risk patients (male only)
  • Family history
  • African American
• Pneumonia vaccine: One time vaccination after 5 years for asplenia, sickle cell anemia, immunocompromise, chronic renal failure or nephrotic syndrome, or if first dose was prior to age 65
• Bone Density Screening
  • High risk for osteoporosis
  • Women with estrogen hormone deficiency, vertebral abnormalities, primary hyperparathyroidism or history of fragility bone fractures; receiving long-term glucocorticoid; or under treatment for osteoporosis