Prenatal-Postpartum Care Guidelines, Paramount Initial Evaluation Height Weight current and prepregnancy Physical examination Ultrasound (body mass index) Cell-free DNA (if older than age 35 or at risk) levels (CBC with difference) Urine test Pap test ABO/Rh typing with antibody screening Rubella antibody titer and varicella VDRL or RPR Hepatitis B surface antigen HIV antibody testing 1-hour glucose tolerance test Cystic fibrosis screening (optional) (offered if not done before pregnancy) Sickle-cell screening offered to African-Americans Test for syphilis and chlamydia Test for gonorrhea (if indicated) Talk with Your Prenatal Provider Complete history Estimated date of delivery and conception Current medication (prescription and over-the-counter) Tobacco use Substance use Signs and symptoms to report to provider Nutrition Environmental exposure Hot tub warning Exercise Evaluate risk for domestic violence Genetic risk and counseling Zika virus warning Influenza vaccine (inactive) during flu season regardless of stage of pregnancy Follow-Up Visits Weight Uterine height Fetal heart tones Fetal movement (to be recorded each visit during the second and third trimesters) Dipstick urinalysis Presence of contractions Presence of swelling Ultrasound (at risk) Quadruple screen at 15 20 weeks offered (Alpha-fetoprotein, b-hcg, unconjugated estriol, inhibin A) Antibody screen at 28 weeks (if Rh-negative; before giving RhoGAM) Hemoglobin or hematocrit at 28 32 weeks gestation 1-hour glucose tolerance test at 28 weeks Group B strep, gonorrhea, chlamydia at 34 35 weeks HIV antibody testing Other lab studies may be ordered based on individual risk factors. Talk with Your Prenatal Provider Childbirth process Infant feeding Choosing child s physician WIC/nutrition Safe infant sleeping environment Birth control Prenatal risk factors RhoGAM (if Rh-negative) Working Air travel during pregnancy Postpartum tubal ligation Circumcision Vaginal birth after cesarean section (if indicated) Umbilical cord blood bank Exercise (Tdap during each pregnancy at 27-36 weeks) Follow-up visits are scheduled every 4 weeks for the first 28 weeks of gestation, every 2 weeks until 36 weeks of gestation, and weekly thereafter. Other services may be required based on individual needs. Postpartum Visits Weight Breasts Abdomen Pelvic exam Episiotomy repair Uterine involution Pap test (if needed) Talk with Your Prenatal Provider Interval history How you are adjusting to newborn Breast-feeding Postpartum visits should be scheduled approximately 4 to 6 weeks after delivery. Evaluation of postpartum depression Birth control Return to work DTap after delivery Safe infant sleeping environment Guidelines are recommendations from Guidelines for Perinatal Care, seventh edition. These are guidelines for members with an uncomplicated pregnancy. Other services may be required based on an individual member s needs and risk factors. Paramount offers 2 postpartum home visits for all Paramount Advantage members. MAC Approved 2016
Senior Adult Preventive Health Care Guidelines, Paramount Female Discuss with Your PCP 65 and older (body mass index) Clinical breast exam annually Colorectal screening Fecal occult blood annually, series of 3 and/or Flexible sigmoidoscopy every 5 years or Colonoscopy every 10 years Bone density screening Lung cancer screening annually ages 55-80 (at risk) BRCA risk and genetic counseling/testing (at risk) Pap test Consider discontinuation of testing after age 65 if previous regular screening results were consistently normal Mammogram (annually) Fasting lipoprotein profile ages 75 and younger every 4-6 years (total cholesterol, LDL, HDL, and triglycerides) HIV (at risk) Chlamydia and gonorrhea screening (sexually active women at increased risk for infection) Syphilis History Injury prevention (especially fall prevention) Drug/alcohol use Tobacco cessation Diet and exercise Sexual behavior Calcium intake Dental health Depression Abuse/neglect OTC vitamins, supplements, and medications Urinary incontinence Tdap (1 dose); then Td (every 10 years) Pneumococcal 23 (1 dose) Varicella (2 doses) Zoster (1 dose) At risk*: MMR; Hepatitis A, B, C; PPD; Meningococcal; Hib; Pneumococcal 13 *For information on at-risk groups, refer to www.cdc.gov/ vaccines/adults/ rec-vac/index.html. * Discuss your individual risks with your health care provider. Male Discuss with Your PCP 65 and older (body mass index) Colorectal screening Fecal occult blood annually, series of 3 and/or Flexible sigmoidoscopy every 5 years or Colonoscopy every 10 years Prostate screening (as recommended by physician with informed consent)* Abdominal aortic aneurysm with history of smoking Lung cancer screening annually ages 55-80 (at risk) Fasting lipoprotein profile ages 75 and younger every 4-6 years (total cholesterol, LDL, HDL, and triglycerides) HIV (at risk) Syphilis (at risk) History Injury prevention (especially fall prevention) Drug/alcohol use Tobacco cessation Diet and exercise Sexual behavior Dental health Depression Abuse/neglect Aspirin therapy ages 45-79 OTC vitamins, supplements, and medications Urinary incontinence Tdap (1 dose); then Td (every 10 years) Pneumococcal 23 (1 dose) Varicella (2 doses) Zoster (1 dose) At risk*: MMR; Hepatitis A, B, C; PPD; Meningococcal; Hib; Pneumococcal 13 *For information on at-risk groups, refer to www.cdc.gov/ vaccines/adults/ rec-vac/index.html. * Discuss your individual risks with your health care provider. Guidelines are recommendations for periodic s from the U.S. Preventive Services Task Force (USPSTF) based on www.ahrq.gov/ clinic/uspstfix.htm. National Cholesterol Education Program recommendations are the guidelines used for cholesterol screening. The immunization schedule is from the Recommended Adult Immunization Schedule, United States, 2016. These guidelines are for preventive health care; other services may be required based on an individual member s needs and risk factors. MAC Approved 2016
Prevention Is Paramount We developed the Paramount Preventive Health Care Guidelines to help you play an active role in your own and your family s health care. You can use the information in these tables to schedule services you need. Please check your benefit package to verify coverage of these services. Regular visits to your Primary Care Provider may help pre vent serious health problems. The information in these tables is appropriate for those with average risk for the conditions named. If you or your family member is at high or above-average risk, or if you have a chronic health condition such as diabetes, talk with your health care provider to de velop a plan that meets your personal health care needs. Important notice: Coverage for services related to Paramount s Preventive Health Care Guidelines may vary by health benefit plan design. Please check your Summary of Benefits or Member Handbook for details. Adult Preventive Health Care Guidelines, Paramount Female Discuss with Your PCP 20 64 years Height Weight (body mass index) Clinical breast exam annually Bone density screening ages 60 64 (at risk)* Colorectal screening age 50* Fecal occult blood annually, series of 3 and/or Flexible sigmoidoscopy every 5 years or Colonoscopy every 10 years Lung cancer screening annually ages 55-80 (at risk) BRCA risk and genetic counseling/testing (at risk) Chlamydia and gonorrhea screening (sexually active females ages 24 and younger and women at increased risk for infection) Syphilis Pap test/cytology* ages 21 65 every 3 years (prefer > 30 cotest cytology with HPV testing every 5 years) Mammogram age 40 annually Fasting lipoprotein profile age 20, every 4-6 years (total cholesterol, LDL, HDL, and triglycerides) Chlamydia age 24 or at increased risk Rubella serology/ vaccination history HIV screening ages 21-65 (nonpregnant women) History Drug/alcohol use Tobacco cessation Diet and exercise Sexual behavior/ contraception Calcium intake Dental health Depression Violence/abuse Aspirin therapy OTC vitamins, supplements, and medications Obesity screening Tdap (1 dose, then Td) HPV < age 26 (3 doses) Varicella (2 doses) MMR ages 20 55 (1 or 2 doses) Zoster > age 60 At risk*: PPD; Pneumococcal; Hepatitis A screening, Hepatitis B screening, Hepatitis C screening; Meningococcal; Hib *For information on at-risk groups, refer to www.cdc.gov/ vaccines/adults/ rec-vac/index.html. * Discuss your individual risks with your health care provider. Male Height Weight (body mass index) Colorectal screening age 50* Fecal occult blood annually, series of 3 and/or Flexible sigmoidoscopy every 5 years or Colonoscopy every 10 years Prostate screening (as recommended by physician with informed consent)* Lung cancer screening annually ages 55-80 (at risk) Discuss with Your PCP 20 64 years Fasting lipoprotein profile age 20, every 4-6 years (total cholesterol, LDL, HDL, and triglycerides) HIV screening ages 21-65 Syphilis (at risk) History Drug/alcohol use Tobacco cessation Diet and exercise Sexual behavior Calcium intake Dental health Depression Violence/abuse Aspirin therapy OTC vitamins, supplements, and medications Obesity screening Tdap (1 dose, then Td) Varicella (2 doses) HPV < age 26 (3 doses) MMR ages 20 55 (1 or 2 doses) Zoster > age 60 At risk*: PPD; Pneumococcal; Hepatitis A screening, Hepatitis B screening, Hepatitis C screening; Meningococcal; Hib *For information on at-risk groups, refer to www.cdc.gov/vaccines/ adults/rec-vac/index.html. * Discuss your individual risks with your health care provider. Guidelines are recommendations for periodic s from the U.S. Preventive Services Task Force (USPSTF) based on www.ahrq.gov/clinic/ uspstfix.htm and the American College of Obstetricians and Gynecologists (ACOG). ACC/AHA (American College of Cardiologists/American Heart Association) recommendations are the guidelines used for cholesterol screening. The immunization schedule is from the Recommended Adult Immunization Schedule, United States, 2016. These guidelines are for preventive health care; other services may be required based on an individual member s needs and risk factors.
Follow this chart if you are ages 60 or older PREVENTIVE SCREENINGS: Date Date Date Cervical Cancer Screening (Pap) (Ask your provider) Breast Cancer Screening (Mammography) (Female age 40, yearly) Colorectal Cancer Screening (Colonoscopy) (Male or female age 50) Every 10 years Colonoscopy Every 5 years Sigmoidoscopy Every year FOBT Bone Density Screening (at least once) Glaucoma (yearly) KNOW YOUR NUMBERS: Blood Pressure LDL IMMUNIZATIONS: Flu Yearly Tdap 1 time, then Td every 10 years Zoster (Shingles, age 60) Pneumococcal (1-time dose age 65) Follow this chart if you are ages 21 59 (fold here and keep in your wallet) (tear here) PREVENTIVE SCREENINGS: Date Date Date Cervical Cancer Screening (Pap) (Female age 21, every 1 3 years) Breast Cancer Screening (Mammography) (Female age 40, yearly) Colorectal Cancer Screening (Colonoscopy) (Male or female age 50) Every 10 years Colonoscopy Every 5 years Sigmoidoscopy Every year FOBT KNOW YOUR NUMBERS: Blood Pressure LDL IMMUNIZATIONS: Flu Yearly Tdap 1 time, then Td every 10 years (fold here and keep in your wallet)
Prevention Is Paramount Practicing preventive health care is the best thing we can do to prevent disease, identify problems soon after they develop, and detect cancer early. Annual visits with your Primary Care Provider (PCP) are recommended along with the screenings on the back of this flap. You may be missing one or more of these screenings. Please use the charts on the back of this flap for your records. Tear off the chart that applies to you, record the date(s) of your last screening/immunization, and fold and carry in your wallet.
Pediatric Preventive Health Care Guidelines, Paramount Infancy Discuss with PCP At Risk Newborn Newborn metabolic/ Critical congenital heart disease Hep B #1 at birth 3 5 days 48 72 hours postdischarge Newborn metabolic/ Feeding Jaundice Hep B #1 if not at birth By 1 month Newborn metabolic/ Hep B #2 2 months Rotavirus #1 DTaP #1 Hib #1 PCV #1 IPV #1 4 months Rotavirus #2 DTaP #2 Hib #2 PCV #2 IPV #2 6 months Hep B #3 Rotavirus #3 DTaP #3 Hib #3 PCV #3 IPV #3 9 months Refer to: www.cdc.gov/ vaccines/ parents/ index.html Consider combination vaccines when possible. Delayed and missed vaccinations increase individual and community risks for vaccine-preventable disease. Guidelines are from the American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care 2015. These guidelines are for preventive care; other services may be required based on an individual member s needs or risk factors. The immunization schedule is based on the Recommended Immunization Schedule for Persons d 0 6 Years, United States, 2016. MAC Approved 2016
Pediatric Preventive Health Care Guidelines, Paramount Early Childhood 12 months Blood lead level (required for Medicaid) Discuss with PCP DTaP #4 (6 months after third dose) Hib #4 PCV #4 MMR #1 Varicella #1 Hep A #1 (2 doses, 6 months apart) At Risk 15 months if not previously given 18 months Hep A #2 (6 months from Hep A #1) 24 months Body mass index () Blood lead level (required for Medicaid) 30 months Body mass index () 3 years Body mass index () Refer to: www.cdc.gov/ vaccines/ parents/ index.html 4 years Body mass index () DTaP #5 IPV #4 MMR #2 Varicella #2 Consider combination vaccines when possible. Delayed and missed vaccinations increase individual and community risks for vaccinepreventable disease. Guidelines are based on the American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care 2015. These guidelines are for preventive care; other services may be required based on an individual member s needs or risk factors. The immunization schedule is based on the Recommended Immunization Schedule for Persons d 0 6 Years, United States, 2016.
Pediatric Preventive Health Care Guidelines, Paramount Middle Childhood Discuss with PCP At Risk 5 years If not yet received: DTaP #5 IPV #4 MMR #2 Varicella #2 6 years Refer to: www.cdc.gov/ vaccines/parents/ index.html 7 years 8 years 9 years (between ages 9 and 11) 10 years (between ages 9 and 11) Adolescence Discuss with PCP At Risk 11 21 years (once between ages 9 and 11 and 18 and 21) Vision test (at ages 12, 15, and 18) Pap test (begin at age 21) Depression (ages 11 21) HIV screening (once between ages 16 and 18) 11 to 12 years old: Tdap HPV series of 3 MCV 13 to 18 years old: MCV booster (ages 16 18 and all college kids in dorms) 1 dose if first dose If not previously given: Tdap HPV series MCV Hep B series IPV series MMR series Varicella Hep A series 16 to 18 years old: MenB Vision test (at ages 11, 13, 14, 16 21) Hearing test Alcohol and drug use (ages 12 17) STI HIV Consider combination vaccines when possible. Delayed and missed vaccinations increase individual and community risks for vaccine-preventable disease. The American Academy of Pediatrics recommends annual visits from ages 11 to 21. Other services may be required based on an individual member s needs or risk factors. Guidelines are from the American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care 2015. These guidelines are for preventive care; other services may be required based on an individual member s needs or risk factors. The immunization schedule is based on the Recommended Immunization Schedule for Persons d 0 6 & 7 18 Years, United States, 2016. MAC Approved 2016