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Click here
for a "pdf" version of the chart below
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Pregnancy
|
Infants
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2-5
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6-11
|
12-17
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18-24
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25-39
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40-59
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60-74
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|
History
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Height/Weight
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Hemoglobin*
|
X
|
|
|
|
|
|
|
|
|
|
Urinalysis
|
X
|
|
|
|
|
|
|
|
|
|
Vision
|
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Hearing
|
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Tuberculosis
|
|
|
|
|
|
|
|
|
|
|
Physical Development
|
|
X
|
X
|
X
|
X
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|
|
|
|
|
Speech
|
|
X
|
X
|
|
|
|
|
|
|
|
Thyroid Function*
|
X
|
X
|
|
|
|
|
|
|
|
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Childhood Immunizations
|
|
X
|
X
|
|
X
|
X
|
|
|
|
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Influenza Vaccine*
|
|
|
|
|
|
|
|
X
|
X
|
|
Pneumonia Vaccine
|
|
|
|
|
|
|
|
|
X
|
|
Blood Pressure
|
X
|
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
|
Scoliosis
|
|
|
|
X
|
X
|
|
|
|
|
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Cholesterol Level*
|
|
|
|
|
|
X
|
X
|
X
|
X
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Breast Exam
|
X
|
|
|
|
X
|
X
|
X
|
X
|
X
|
|
Screening Mammogram
|
|
|
|
|
|
|
X
|
X
|
X
|
|
Pap Smear
|
|
|
|
|
|
X
|
X
|
X
|
X
|
|
Sexually Transmitted Diseases*
|
|
|
|
|
|
|
|
|
|
|
Pelvic Exam
|
X
|
|
|
|
|
X
|
X
|
X
|
X
|
|
Rectal Exam
|
X
|
|
|
|
|
X
|
X
|
X
|
X
|
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ECG*
|
|
|
|
|
|
|
|
X
|
|
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Blood Glucose Level*
|
X
|
|
|
|
|
|
|
X
|
X
|
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Occult Blood in Stool
|
|
|
|
|
|
|
|
X
|
X
|
|
Amniocentesis (over 35, +/-)
|
X
|
|
|
|
|
|
|
|
|
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Rubella Screening
|
X
|
|
|
|
|
|
|
|
|
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RH & Blood Group Determination
|
X
|
|
|
|
|
|
|
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* Based upon personal and family history
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