Schedule

Every year. The recommended schedule applies only to the periodic visit itself. The frequency of the individual preventive services is left to clinical discretion (except as indicated). The preventive services are listed below.

DISCLAIMER: Coverage of preventive services varies under PPO and indemnity plans. Members covered under these policies need to refer to their Certificate of Coverage or contact a customer service representative for information regarding covered services.

Screening:

History:

• Prior symptoms of transient ischemic attack
• Dietary intake
• Physical activity
• Tobacco/alcohol/drug use
• Functional status at home

Physical Exam:

• Height and weight
• Blood pressure
• Visual acuity
• Hearing and hearing aids
• Clinical breast exam-annually for women

  High Risk Groups:

• Auscultation for carotid bruits [HR1]
• Complete skin exam [HR2]
• Complete oral cavity exam [HR3]
• Palpation for thyroid nodules [HR4]

Laboratory:

• Nonfasting total blood cholesterol- every 5 years to age 75
• Mammogram annually for women
• Fecal occult blood-annually and/or sigmoidoscopy -- 3-5 years

  High Risk Groups:

• Plasma glucose [HR5]
• Tuberculin skin test (PPD) [HR6]
• Electrocardiogram [HR7]
• Papanicolaou smear-every 1-3 years [HR8]
• Fecal occult blood/sigmoidoscopy [HR9]
• Fecal occult blood/colonoscopy [HR10]

Immunizations and/or Chemoprophylaxis

• Tetanus-diphtheria(Td) booster-every 10-30 years
• Influenza vaccine-annually
• Pneumococcal vaccine-once if not given previously

  High Risk Groups:

• Hepatitis B vaccine [HR16]

Patient and/or Parent Counseling

Diet and Exercise:

• Fat (especially saturated fat), cholesterol, complex carbohydrates, fiber, sodium and calcium (for women).
• Caloric balance
• Selection of exercise program

Substance Use:

• Tobacco cessation
• Alcohol and other drugs: limiting alcohol consumption. Driving/other dangerous activities while under the influence. Treatment for abuse.

Injury Prevention:

• Prevention of falls
• Safety belts
• Smoke detector
• Smoking near bedding or upholstery
• Hot water heater temperature

  High Risk Groups:

• Prevention of childhood injuries [HR12]

Dental Health:

• Regular tooth brushing, flossing, dental visits

Other Primary Prevention Measures:

• Glaucoma testing by eye specialist

  High Risk Groups:

• Discussion of estrogen replacement therapy [HR13]
• Discussion of aspirin therapy [HR14]
• Skin protection from ultraviolet light [HR15]

Remain Alert for:

• Depressive symptoms
• Suicide risk factors [HR11]
• Abnormal bereavement
• Changes in cognitive function
• Medications that increase risk of falls
• Signs of physical abuse or neglect
• Malignant skin lesions
• Peripheral arterial disease
• Tooth decay, gingivitis, loose teeth

Leading Causes of Death

• Heart disease
• Malignant neoplasms (lung, colon, breast)
• Cerebrovascular disease
• Chronic obstructive pulmonary disease
• Pneumonia and influenza

Definitions of High Risk Patients

These definitions apply to the category of Ages 65 and Over only.

TERM DEFINITION

• HR1: Persons with risk factors for cerebrovascular or cardiovascular disease (e.g., hypertension, smoking, CAD, atrial fibrillation, diabetes) or those with neurologic symptoms (e.g., transient ischemic attacks) or a history of cerebrovascular disease.
  
  
• HR2: Persons with family or personal history of skin cancer, increased occupational or recreational exposure to sunlight, or clinical evidence of precursor lesions (e.g., dysplastic nevi, certain congenital nevi).
  
  
• HR3: Persons with exposure to tobacco or excessive amounts of alcohol, or those with suspicious symptoms or lesions detected through self-examination.
  
  
• HR4: Persons with a history of upper-body irradiation.
  
  
• HR5: The markedly obese, persons with a family history of diabetes, or women with a history of gestational diabetes.
  
  
• HR6: Household members of persons with tuberculosis or others at risk for close contact with the disease (e.g., staff or tuberculosis clinics, shelters for the homeless, nursing homes, substance abuse treatment facilities, dialysis units, correctional institutions); recent immigrants or refugees from countries in which tuberculosis is common (e.g., Asia, Africa, Central and South America, Pacific Islands); migrant workers; residents of nursing homes, correctional institutions, or homeless shelters; or persons with certain underlying medical conditions (e.g., HIV infection).
  
  
• HR7: Persons with two or more cardiac risk factors (high cholesterol, HBP, cigarette smoking, diabetes mellitus, family history of CAD); persons who would endanger public safety were they to experience sudden cardiac events (e.g., commercial airline pilots); or sedentary or high-risk persons planning to begin a vigorous exercise program.
  
  
• HR8: Women who have not had previous documented screening in which smears have been consistently negative. Women who have had a hysterectomy without evidence of malignancy do not require a pap smear.
  
  
• HR9: Persons who have first-degree relatives with colorectal cancer; a personal history of endometrial, ovarian, or breast cancer; or previous diagnosis of inflammatory bowel disease, adenomatous polyps or colorectal cancer.
  
  
• HR10: Persons with a family history of familial polyposis coli or cancer family syndrome.
  
  
• HR11: Recent divorces, separation, unemployment, depression, alcohol or other drug abuse, serious medical illnesses, living alone, or recent bereavement.
  
  
• HR12: Persons with children in the home or automobile.
  
  
• HR13: Women at increased risk for osteoporosis (e.g., Caucasian, low bone mineral content, bilateral oophorectomy before menopause or early menopause, slender build) and who are without known contraindications (e.g., history of undiagnosed vaginal bleeding, active liver disease, thrombo-embolic disorders, hormone-dependent cancer).
  
  
• HR14: Persons who have risk factors for myocardial infarctions (e.g., high blood cholesterol, smoking, diabetes, family history of early-onset CAD) and who lack a history of gastrointestinal or other bleeding problems, and other risk factors for bleeding or cerebral hemorrhage.
  
  
• HR15: Persons with a family history of skin cancer, multiple moles, or light skin/hair/eyes.
  
  
• HR16: Homosexually active men, intravenous drug users, recipients of some blood products, or persons in health-related jobs with frequent exposure to blood or blood products.