ADULT WELLNESS VISIT & WELL WOMAN EXAM
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- Barbra Baker
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1 *This timeframe is the average amount of time most patients spend with the Medical Assistant and Provider, complete any ordered testing in the office (e.g. lab, x-ray, EKG, spirometry, etc.) and check-out to schedule future visits. Patients should allow minutes of additional time prior to their visit for check-in and required paperwork. **Patients should refer to their health insurance plan benefits and our payment policies for additional information. A copy of our payment policies is available at our office or online at The out-of-pocket cost range listed is determined by the provider and covers only the face-to-face visit with the provider. Additional costs include any testing in the office (e.g. lab, x- ray, EKG, spirometry, etc.), immunizations/injections and/or surgical procedures. What is a Wellness Visit? ADULT WELLNESS VISIT & WELL WOMAN EXAM This visit is best for patients who feel well and want an evaluation of their general health condition. (Also known as annual or physical exam.) The visit includes age-specific health screening and disease prevention services recommended by the U.S. Preventive Services Task Force and most insurance plans. This visit also allows time to discuss life issues, healthy behaviors and concerns on health topics. Typical services include: Vital signs, including body mass index (BMI) calculation Mental health screening Diet and exercise counseling Sexually transmitted disease counseling Certain immunizations Testing for cholesterol, blood sugar and/or other lab work (if applicable) Referrals for mammography and colonoscopy (if applicable) Cervical cancer screening, including pelvic exam and PAP smear (generally recommended every 3 years); oral contraceptive (i.e. birth control) refills are included as a covered service by health insurance carriers New/established patient: Insurance carriers allow only 1 wellness visit per calendar or benefit year minutes Insurance: typically covered 100% New patient: $171-$218 (based on age) Established patient: $140-$171 (based on age)
2 What is a Medicare Wellness Visit? MEDICARE WELLNESS VISIT This visit is for patients with Medicare Part B only. It includes a review of your medical history and counseling about preventive services. The visit does not include a physical exam, medication changes/refills, lab testing and immunizations. A one-time Welcome to Medicare Visit includes the following services and referrals for other care, if needed. Height, weight and blood pressure measurements Body mass index (BMI) calculation Vision test Review potential risk for depression and your level of safety An open-ended discussion about creating advance directives A written plan letting you know which screenings, vaccines, and other preventive services you may need Annual Wellness Visits are designed to develop a personalized plan to prevent disease and disability. Review of your medical and family history Updating a list of current providers and prescriptions Height, weight and blood pressure measurements Detection of any memory impairment Personalized health advice A list of risk factors and treatment options for you A screening schedule for appropriate preventive care Medicare covers only one wellness visit per year. Annual visits are recommended. 45 minutes Visits are covered 100% by Medicare Part B. What is a Well Child Visit? WELL CHILD CARE The purpose of this visit is to assess your child s growth and development and provide guidance for health and safety. Your child will receive a developmental screening and physical exam. Common services include: Height, weight and blood pressure measurements Vision test Review of your child s medical and family history Nutrition and exercise counseling Child safety counseling Immunizations Other services may be recommended by your provider based on your child s age and developmental stage. Visits are recommended based on your child s age. Generally, these visits are recommended multiple times per year as an infant and then annually after age minutes Insurance: typically covered 100% by insurance New patient: $152-$171 (based on age) Established patient: $116-$150 (based on age)
3 What is a Medical Management Visit? MEDICAL MANAGEMENT The purpose of this visit is to manage long-lasting diseases and conditions such as diabetes, heart disease, high blood pressure, high cholesterol, asthma, COPD, depression and any condition requiring long-term prescriptions. Depending on your disease or condition, your provider will: Review/refill medications Discuss the impact of your condition to your overall health Perform a targeted physical exam, as needed Order lab, EKG, spirometry or other testing Conduct health screenings and disease prevention services (e.g. diabetic foot exam, vaccines etc.) New patient: Please contact us to schedule if you presently have a chronic disease or condition and are not receiving regular evaluation and treatment. Established patient: Visits should be scheduled either at 3 or 6 month intervals as recommended by your provider minutes What is a Routine Office Visit? ROUTINE OFFICE VISIT This visit includes evaluation and treatment of new issues or conditions as well as follow-up visits. Some examples are fever, colds, sprains, injuries, pain, dizziness, rashes or diarrhea. The services you receive may vary based on the reason of your visit and provider discretion. Common services include: Diagnose and treat illness or injury Order medications Order and/or review lab and other testing Request referrals Follow up and continue care received from a specialist or hospital visit Complete health-related documentation (e.g. FML forms, disabled parking permit, etc.) Please contact us to schedule when you need any of the above or other services. New patient: minutes Established patient: minutes
4 What is a Team Visit? TEAM CARE VISIT This visit is designed to add self-management support for patients managing chronic diseases and conditions such as diabetes and heart disease. You will meet with your medical provider and our Health Coach during your visit. The team will help you identify a personal health goal and provide the self-help tools to reach your goal and improve your health. This visit is also called an Extended Office Visit by your provider or WMC staff. Depending on your disease or condition, your medical provider will provide the following services: Evaluate your health status and control of the condition Review/refill medications Discuss the impact of your condition to your overall health Order lab, EKG, spirometry or other testing Conduct preventive screenings (e.g. diabetic foot exam, vaccines, etc.) In coordination with your medical provider, the Health Coach will work with you to identify and improve your health and decrease factors that contribute to chronic illness and disease such as diet and exercise. Please speak with your medical provider about scheduling a team visit minutes Please note that you will meet with the Health Coach for the first 30 minutes of this visit and then with your medical provider for the remaining time. What is a Motor Vehicle Accident visit? MOTOR VEHICLE ACCIDENT This visit is for patients with injuries resulting from a motor vehicle accident or who were injured by a motor vehicle as pedestrians or while riding a motorcycle/bicycle. A combination of treatments including medical, chiropractic and health coaching may be recommended to treat your injuries. If outside testing or treatment is required, your provider will refer you to appropriate care. Your provider will also provide any requested documentation you may need to submit for a motor vehicle claim. Please contact us to schedule when you are experiencing symptoms of possible injury from a motor vehicle accident. Medical: minutes Chiropractic: 60 minutes Insurance: Covered by motor vehicle insurance until benefit limit is reached, if applicable Office visit or chiropractic copay or deductible/coinsurance for health insurance for medical, $125 for chiropractic for medical, $65 for chiropractic
5 What is a Virtual Visit? spend for my visit?* VIRTUAL VISIT This non-traditional visit using a secured, web-based video meeting service allows you to meet with your provider at the comfort of your home and discuss test results and related treatment follow-up. **This type of visit is not available for emergency or urgent care.** The visit is limited to reviewing lab or test results only. New patient: not available Established patient: Please schedule this visit after your lab visit following your provider s recommended timeframe. New patient: not available Established patient: 10 minutes All patients must pay $45 out of pocket. Insurance does not provide coverage for this service. What is a Functional Medicine Visit? FUNCTIONAL MEDICINE VISIT Functional medicine is a holistic approach to treating complex health issues. Your provider will use this approach to identify and correct the root causes of health issues instead of focusing on treating symptoms. Functional medicine considers the interaction among genetics, environment and lifestyle with your overall health. Your visit will include a thorough review of how these factors impact you and recommendations for improving your health through managing these factors. Your provider may recommend any or all of the following as part of your diagnosis and treatment: Specialized lab, DNA and/or other testing Nutrition/diet changes Supplements Lifestyle management (e.g. sleep, stress, health coaching, mental health, etc.) Please speak with your medical provider to determine if functional medicine could help treat your particular health issues. 60 minutes. Typically, it will take 6-10 visits to achieve patient-provider goals. (not including lab or other testing, supplements or visits with other providers)
6 What is chiropractic care? CHIROPRACTIC CARE/CORE Chiropractic care focuses on disorders of the muscular, skeletal and nervous systems and how these disorders affect general health. Chiropractic care treats common issues such as back pain, neck pain, pain in the joints of the arms or legs, and headaches. A physical examination will determine which therapy would best address your condition. These include a variety of therapies such as spinal adjustment to realign the spine and acupuncture to relieve muscle tension, pain or aches. Please contact us to schedule when experiencing muscular or skeletal issues New patient: 60 minutes Established patient: 20 minutes Insurance: chiropractic copayment or deductible New patient: $125 Established patient: $65 What is a Health Coaching visit? HEALTH COACHING Health coaching is a one-on-one, personalized visit designed to help you lead a healthier lifestyle by providing tools, resources and an action plan that works for you. Many aspects of life contribute to your overall health. Common topics to address with the Health Coach include: Chronic illness (e.g. diabetes, heart disease, high blood pressure, high cholesterol, etc.) Nutrition and exercise, including weight loss Personal life, including tobacco cessation During your visit, the Health Coach will work with you to help you find your motivation and create an action plan to achieve your goals. Anyone who wishes to achieve optimal health would benefit. Please speak with your medical provider about integrating health coaching with your medical care. 60 minutes All patients must pay $39 out of pocket. Insurance does not provide coverage for this service.
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Schedule of s Harvard Pilgrim Health Care, Inc. THE HARVARD PILGRIM HMO MAINE ID: MD0000017741_A4 X This Schedule of s states any Limits and Member Cost Sharing amounts you must pay for Covered s. However,
Schedule of Benefits Summary Group Name: Nebraska Bankers Association VEBA Effective Date: January 01, 2018
Schedule of Benefits Summary Group Name: Nebraska Bankers Association VEBA Effective Date: January 01, 2018 Payment for Services Covered Services are reimbursed based on the Allowable Charge. Blue Cross
Vitals: Ht: Wt: BP: P: SP02: BMI:- What is main reason for seeking treatment? VAS: (0-10)
INITIAL INITIAL INTAKE INTAKE EXAMINATION Health History of Exam: Vitals: Ht: Wt: BP: P: SP02: BMI:- What is main reason for seeking treatment? VAS: (0-10) What, if anything has made the problem worse?
First Name Middle Last Today s Date / / Age Male/Female Date of Birth / / SS# - - Address City State ZIP Phone: Home Cell Phone Provider Address
First Name Middle Last Today s Date / / Age Male/Female Date of Birth / / SS# - - Address City State ZIP Phone: Home Cell Phone Provider Email Address Do you have Medicaid? Y / N (present your card to
2017 Preventive Schedule
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Dr. Brett A. Morgan PATIENT INFORMATION TRUE HEALTH Chiropractic Physician Applied Kinesiologist So. Charleston, WV PERSONAL INFORMATION
Page1 PERSONAL INFORMATION Last Name First Nickname Middlle Initial Prefix Generation Sex DOB SSN Marital Status Height Weight Address City State Zip Phone (Home) (Work) (Cell) Email Occupation Employer
Manage Your Health with Preventive Care
Manage Your Health with Preventive Care Preventive care is routine health care that focuses on maintaining your health and preventing disease. This can include annual physical examinations, screenings
Schedule of Benefits Summary Group Name: Nebraska Bankers Association VEBA Effective Date: January 01, 2018
1 Schedule of Benefits Summary Group Name: Nebraska Bankers Association VEBA Effective Date: January 01, 2018 Payment for Services Covered Services are reimbursed based on the Allowable Charge. BlueCross
2016 Preventive Health Care Guidelines. Free preventive care to help you be your healthiest.
2016 Preventive Health Care Guidelines Free preventive care to help you be your healthiest. We want to help you be your healthiest. That s why we recommend over 30 free preventive care services for kids,
2018 Preventive Schedule Effective 1/1/2018
2018 Preventive Schedule Effective 1/1/2018 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The
Healthcare Reform Preventive Services
An Independent Licensee of the Blue Cross and Blue Shield Association The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue
Preventive care covered with no cost sharing Get checkups, screenings, vaccines, prenatal care, contraceptives and more with no out-of-pocket costs
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions NOTE: Aetna Choice follows the recommendations of the United States Preventive Services Task Force (USPSTF).
CONTINUUM CHIROPRACTIC ADULT HEALTH HISTORY FORM
CONTINUUM CHIROPRACTIC ADULT HEALTH HISTORY FORM Today s Date PERSONAL DATA Legal Name Preferred Name Age Date of Birth Height Weight Home Address City State Zip Home phone ( ) Business Phone ( ) Cell
Thrive Family Chiropractic
Thrive Family Chiropractic Dr. Kaitlin Parker, DC 1121 S. Bowman, Suite C-3 Little Rock, AR 72211 501.712.1022 Pediatric Vitality Questionnaire Name: Date: Birth Date: Gender: Male Female Parent s phone
Schedule of Benefits Summary Group Name: Nebraska Bankers Association VEBA Effective Date: January 01, 2018
Schedule of Benefits Summary Group Name: Nebraska Bankers Association VEBA Effective Date: January 01, 2018 Payment for Services Covered Services are reimbursed based on the Allowable Charge. Blue Cross
Who may we thank for referring you?
NEW PRACTICE MEMBER APPLICATION Name Date of Birth / / Age Male/Female Address City State Zip Phone: Cell Home Social Security #: Email: Occupation Employer s Name Status: Single / Married / Divorced /
2017 Preventive Health Care Guidelines
2017 Preventive Health Care Guidelines NEXT All Adults 4 Women 6 Pregnant Women 8 Children 10 Guidelines may change throughout the year based on new research and recommendations. Get the most up-to-date
HealthyBlue Living SM
Deductible, Copays and Dollar Maximums Deductible Fixed Dollar Copays Coinsurance Annual Coinsurance Maximum (ACM) Out of Pocket Maximum - applies to deductibles, copays and coinsurance amounts for all