Significant Past Medical History:
Screening Dates
Last Physical:
Women’s health
-Pap Smear (≥ 21 yrs):
-Mammogram (≥ 40 yrs):
-DEXA Scan (≥ 65 yrs):
Men’s Health
-Abdominal U/S (AAA Screen – 65-75 yr who have ever smoked):
-PSA:
Colon cancer screening
-Colonoscopy (≥ 50 yrs):
-Stool Guaiac (≥ 50 ):
Diabetes patients
-Ophthalmology Evaluation:
-Monofilament:
-HbA1c:
Lipid Screen:
Pneumonia Vaccine :
Flu Vaccine (everyone):
Tetanus (every 10 yrs):
EKG:
CXR:
Hepatitis Screen:
STD Screen:
TB Screen:
Vision Screen:
Hearing Screen :
Optometry:
Dental: