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7 blood tests to ask for at your annual physical + how to get them covered by insurance.

If you're remotely health-conscious, you probably get an annual physical during which your doctor asks how you've been feeling, does a brief exam, and occasionally (but not always) orders some blood work. Maybe she spouts off the names of a couple of lab tests she's ordering, like a CBC or CMP—but rarely does anyone explain what exactly these tests are looking for. So you get your blood drawn, get a call a few days later that things came back "normal," and you don't really think much about it until next year. 

And again, that's if your doctor calls for any blood work at all. I actually went from age 25 to 30 with zero labs from my general practitioner, even though I have a family history of heart disease and high cholesterol. 

On the other end of the spectrum, though, you know there are functional and integrative docs out there who tout all sorts of medical tests (from inflammatory markers to food sensitivities) that supposedly help spot problems early on and offer intel on how you might tweak your diet and lifestyle to optimize your health. But not everyone has access to this type of practitioner, and not all of these tests are covered by insurance. 

So then the question becomes: What's a happy medium between bare-bones and borderline excessive lab testing? If you're seriously proactive about optimizing your health and preventing issues, what are the key tests to consider getting done semi-regularly that pretty much any doctor can order and that will most likely be covered by insurance? 

It's important to note that everyone's health insurance coverage is different. This article will make a note of which tests are very likely, pretty likely, and less likely to be covered, but you can increase your chances of getting the tests you need (and getting them paid for) if you take the following steps before/during your next appointment: 

• Write down your family history of diseases and illnesses, which relative had them, and at what age. This could qualify you for certain medical tests you may not otherwise be qualified for. "If I have certain verbiage from you, I can get away with ordering more tests," says Bindiya Gandhi, M.D. , a family medicine physician trained in functional medicine. "If you have fatigue and a family history of hypothyroidism, by me adding that diagnostic code, I could probably run a more extensive thyroid panel."
• Keep a symptom journal, noting any changes to your health since your last visit, including new aches and pains, increased fatigue, hair loss, weight gain or loss, etc. 
• If you're seeing a new doctor, have all your recent lab work sent over. This will help them compare test results over time and determine what testing may be justified now.
• If there's ever a question, call your specific insurance company to confirm coverage. 

These are the medical tests most adults (particularly women) should consider getting annually.

Here, with guidance from top docs, is a rundown of the lab tests you may want to consider getting on an annual, or at least semi-regular basis. We start with some of the most basic tests that will almost definitely be covered by insurance, then dive into some that are often warranted based on common symptoms and/or if you have a family history. 

Complete Blood Count (CBC)

A complete blood count (CBC) is one of those basic tests that's often included as part of an annual checkup—or that will be if you ask for it. It measures different features of your blood, including red blood cells, white blood cells, platelets, hemoglobin, and hematocrit. 

"A CBC will find anemia, which is common among menstruating women, and it's also a screening test for immune system issues and different types of cancer—blood cancers that can happen in young people," says Chloe Godwin-Gorga, M.D. , an integrative primary care physician. "So if you get a wonky CBC, it's a reason to be more thoroughly evaluated. That's why it's a really good basic test." 

Who should get it? All adults.

Coverage: A CBC is very likely to be covered by insurance as part of your annual physical.

Comprehensive Metabolic Panel (CMP)

Another basic but goody is a comprehensive metabolic panel (CMP), which reveals information about your overall metabolism, including kidney and liver function and type 2 diabetes risk.

It typically includes a measure of your fasting blood glucose , which may not be the best test for predicting diabetes risk or blood sugar imbalances but gives you a general idea (pro tip: A fasting blood glucose of less than 100 mg/dL is considered "normal," but most functional docs would like to see that number at around 70 or 80 mg/dL, says Heinz). It also looks at electrolytes like sodium, calcium, and potassium, which can indicate whether you're dehydrated, and it's a screening test for your liver and kidney function.

Coverage: A CMP is very likely to be covered by insurance as part of your annual physical.

Hemoglobin A1C (HbA1C)

As mentioned above, a fasting blood glucose test (which is typically part of a CMP) isn't always the best indicator of blood sugar dysregulation. According to all of the doctors I spoke with, one of the best ways to get a heads-up about blood sugar issues, insulin resistance, and prediabetes before they manifest as serious health problems is with a hemoglobin A1C test 1 (HbA1C). 

An HbA1c test measures the percentage of red blood cells saturated with glucose. The higher your A1C, the higher the estimated average blood glucose. Your HbA1c number is generally considered to correlate to your average blood glucose over two to three months—not just a single day. In addition to diabetes, a high HbA1C marker may also increase your risk of Alzheimer's disease and cancer—potentially making the test a good predictor of overall longevity. 

"Interestingly, in young women, having a high HbA1c is also associated with having polycystic ovaries (or PCOS ), which can make it really hard to conceive," says Godwin-Gorga. "So if you're headed in that direction and your periods are a bit irregular, finding out that number can provide the motivation to make changes to your eating and exercise habits that benefit overall fertility and metabolism." Then, you can retest in three to six months to see if you've moved the needle. Ideally, you'll want your HbA1C to be 4 to 5.3, though lower is better.

Who should get it? Preferably all adults, particularly if you're overweight, at increased risk of diabetes, struggling with fertility or symptoms of PCOS , or over age 45.

Coverage: An HbA1C test is pretty likely to be covered by insurance, but check first.

Lipid Panel (ideally with particle size)

For a broad picture of heart health, you at least want a standard lipid panel , which is a measure of your HDL ("good") cholesterol, LDL ("bad") cholesterol, and triglycerides. But while this is certainly a good baseline test, especially if you have no heart disease risk factors, many functional and integrative doctors don't believe it goes far enough. That's because, even though high LDL cholesterol has consistently been linked to heart disease, there are still some people with normal or even low LDL levels 2 that develop heart disease—so there's more to the story.

Increasingly, integrative doctors, including Gandhi, Amy Shah, M.D. , and Kristann Heinz, M.D., R.D. , are calling for more advanced lipid panels, like those that include a breakdown of lipoprotein size (cholesterol particle size). Research suggests that looking at numbers of specific particles is more indicative of your risk than simply zeroing in on total or LDL cholesterol. Basically, you want your particles to be big and buoyant, not small and heavy, because then they tend to lodge in the walls of arteries more easily, which can increase your risk of heart attack and stroke.

If your insurance doesn't cover a more advanced lipid panel, you shouldn't stress—but you should look at the numbers on your standard lipid panel more closely. "One of the strongest predictors for preventing heart disease is having a good HDL-to-triglycerides ratio," says Steven Gundry, M.D. , cardiologist and functional primary care physician. "So your HDL should be higher than or equal to triglycerides." 

Who should get it? All adults, especially if you have a family history of heart disease or other risk factors.

Coverage: A standard lipid panel is very likely to be covered by insurance as part of your annual physical, while more advanced lipid testing may depend on your risk or family history.

Thyroid Panel (or at least a TSH test) 

Thyroid disorders are incredibly common , affecting one in 10 women, and about 60% of people with a thyroid problem are unaware of their condition—and thus, unable to manage it appropriately. Hypothyroidism (or low thyroid function), especially the common autoimmune type called Hashimoto's thyroiditis , is often missed as a hidden cause of fertility problems and pregnancy loss.

This is why nearly every doctor I spoke with recommended some degree of thyroid testing for women (at least a thyroid-stimulating hormone, or TSH, test), and a more comprehensive thyroid panel for women experiencing unexplainable weight gain or loss, chronic fatigue, cold intolerance, hair loss, forgetfulness, constipation, and feeling generally depressed. For these women, Godwin-Gorga likes to run a panel of five tests: TSH, free T4, free T3, reverse T3, and two types of thyroid antibody levels called anti-TPO and anti-thyroglobulin.

TSH alone can miss many cases of Hashimoto's. That's because thyroid function is very erratic (or up and down) in the early stages of this condition—so TSH levels may actually be normal at the time of your test, even if thyroid function is compromised. A more comprehensive panel can spot issues early while they can still be addressed with lifestyle changes.

Who should get it? Monitoring your TSH levels over time is a good idea for most women, and a more extensive thyroid panel may be warranted for women with the symptoms above and/or a family history. 

Coverage: Thyroid testing is often covered by insurance if you're experiencing symptoms like fatigue. In some cases, you may need to start with a TSH test first and go from there. 

Another go-to test among functional docs, particularly if you're experiencing fatigue, is a 25-hydroxy vitamin D blood test. "The majority of my patients are actually vitamin D deficient 3 ; that's why it's part of my standard panel of tests," says Gandhi. This can occur for a number of reasons. "Geographically, many of us aren't exposed to enough sun year-round, some people have a genetic mutation so they can't synthesize vitamin D from sunlight, and we're also taught to wear sunscreen." 

Shah echoes this sentiment: "I check vitamin D levels on almost every woman," she says, adding that this vitamin and hormone-precursor plays a key role in immune function and mood. Deficiencies in vitamin D can also be a factor in autoimmune disease and certain cancers.

When it comes to vitamin D levels, keep in mind that a "normal" test result, which is anywhere from 30 to 80 ng/mL, does not necessarily indicate "optimal"—ideally, you want it above 50 ng/mL, says Gandhi. If you're below that, supplementation will likely be necessary.

Who should get it? Most adults, particularly women and those experiencing fatigue and poor mood.

Coverage: Vitamin D testing is typically covered if you're experiencing symptoms.

Anemia Panel (or iron, ferritin, folate, and vitamin B12)

So far, this piece has referenced fatigue and low energy a lot—because, unfortunately, these are pretty common symptoms among U.S. adults, especially women. In addition to thyroid issues and low vitamin D, another potential cause of waning energy levels is low levels of a few key nutrients: iron, ferritin (the stored form of iron), folate, and vitamin B12. Your doctor can test for these separately or all at once on an anemia panel, says Godwin-Gorga.

Low vitamin B12 is common among vegetarians and vegans but can also exist among omnivores due to nutrient malabsorption issues caused by antibiotic overuse, or celiac or Crohn's disease. Folate plays a crucial role in healthy pregnancy and preventing birth defects but often is not screened. And pretty much any menstruating woman has the potential to be low in iron. So, this combo of tests can be pretty revealing—and low levels can be easily remedied. 

"Iron is an interesting one," says Godwin-Gorga. "It affects your thyroid, and if your iron is low, it can present as hypothyroidism. It's so common for women to feel normal once we replenish their iron." And interestingly, even if you're not anemic (which can be tested for with a CBC), you can still be iron deficient—which is why testing for iron and ferritin separately is important. 

Who should get it? People experiencing fatigue, particularly if you're a menstruating woman, or if you follow a plant-based diet. 

Coverage: Pretty much everyone with a period who's experiencing fatigue can get an anemia panel covered by insurance, says Godwin-Gorga. 

After your labs are completed.

One of the biggest issues with medical testing—even if you do manage to get some good tests ordered by your primary care physician—is that you may not know what to do with the results. "I think one of the big lapses in primary care right now is that no doctor is really giving you good feedback on what the numbers mean," says Godwin-Gorga. "It takes them getting abnormal before anyone even says something to you. But there's a lot of room to say, 'Hey, this is not optimal ; let’s talk about that.'"

So, what's the solution?

• First, schedule a call or follow-up appointment to discuss your labs and what they mean. Often doctors won't explain your results in detail (especially if they're "normal") because they simply don't have time. If you want guidance on whether your TSH test result, which was on the high end of normal, is actually optimal for someone like you, ask them. If you do your homework and ask targeted questions, you're more likely to get some opinions, says Godwin-Gorga.
• If you're not getting the guidance you need, consider getting a second opinion from a functional or integrative doc. "If you feel like your doctor's not being responsive to you, then always seek another set of eyes," says Godwin-Gorga. "I have people bring me their labs from other doctors all the time, and I'll say, here's what I think they mean, and here are some other tests I'd consider adding." Heinz echoes this sentiment: "Taking your bloodwork to someone who feels comfortable looking at your results in terms of optimal ranges versus standard/normal ranges can give you a world of information about how to start making changes," she says. Of course, not all functional/integrative doctors take insurance, but since you already have your bloodwork done, an office visit or a virtual visit probably won't break the bank.

Bottom line: Getting the right tests (for you) can be empowering.

In most cases, you don't need to run a bazillion tests to get a good picture of your health and what you can do to optimize it. Start by doing your homework. Write down any ongoing or new symptoms and a complete family history—then, ask your doctor what tests they think you should get based on this, and have a discussion about some of the specific tests mentioned above if you feel they may be warranted. Also remember, how your labs are interpreted is just as important as getting them done in the first place—and if you want more guidance on what you should do based on your results (in terms of lifestyle changes or further testing), probe your doctor for more details or get a second opinion. And remember, always call your insurance company to ask about coverage! 

*Keep in mind: This article does not cover every single medical test or screening that you may need. Always consult with your doctor—getting second opinions when necessary—to come up with the testing regimen that's best suited for you.

• https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597070/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/

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Confused About Your Health? The Answer May Be in Your Blood

Blood testing is a routine part of preventive health. We use them to monitor health and diagnose any medical problems that may occur.

These tests are generally simple, with almost no risk and minimal discomfort.

This article discusses the uses and types of blood tests and how to interpret the results.

What Can Blood Tests Detect?

When you have a blood test, a sample of blood is sent to a laboratory and tested for different cells and substances. Often, the amount, size, and concentration of the cells and substances are reported with numerical values that are compared to standard or ideal values. 

Examples of what can be tested in the blood include:

• Glucose (blood sugar)
• Types of cells, such as white blood cells, red blood cells, and platelets 
• Minerals, such as potassium, calcium, and iron 
• Fat and cholesterol 
• Vitamins, such as vitamin B12 and vitamin D 
• Hormones, such as thyroid hormones and estrogen
• Inflammatory markers, such as erythrocyte sedimentation rate (ESR or sed rate) and antinuclear antibodies (ANA)
• Tumor markers , such as CA 125
• Genetic markers
• Toxins, such as lead
• Drugs or medications
• Oxygen and carbon dioxide levels

Blood tests can be used to detect signs of health risks, infection, and the balance of fluids and minerals in the blood. They can also be used as an assessment of physical functions.

Blood Test Process

Blood tests can measure certain components when the blood is taken to a lab and combined with specific chemicals that detect certain cells, proteins, hormones, and enzymes. Blood test technology is always improving, and some blood tests can identify diseases that couldn’t be easily diagnosed years ago.

Types of Blood Tests

If you are having a blood test, you will have an order that specifies which tests you need. Some blood tests require preparation to ensure accurate results. Preparation may involve fasting (not eating or drinking) for a set amount of time prior to having the test or making certain medication adjustments.

During the test, the blood is placed into tubes that correspond to the type of tests you are getting. Some tubes contain material to maintain the components that are being tested. Then the sample is sent to the laboratory for testing.

Below are common types of blood tests.

Complete Blood Count (CBC)

A complete blood count is a very common blood test, and it measures the number of blood cells and the percentage of each type of blood cell. 

A CBC includes:

• Red blood cells (RBCs) : RBCs carry oxygen and carbon dioxide throughout the body. The number of RBCs is reported, as well as their size and hemoglobin (the protein that carries oxygen) and hematocrit (the percentage of blood volume that is RBCs) levels. 
• Platelets : These are small cell particles that help the blood clot, a process that promotes healing and prevents excess bleeding.
• White blood cells (WBCs) : Several types of WBCs, including neutrophils, monocytes, and erythrocytes, help the body fight infections and heal from disease. 

A CBC also provides information about the size of each blood cell type. The results can help your healthcare provider determine if you may have anemia (a low number of healthy red blood cells), an infection, or indicators of other conditions.

Basic Metabolic Panel (BMP)

The basic metabolic panel blood test measures glucose, calcium , sodium, potassium, chloride, creatinine , blood urea nitrogen (BUN), and bicarbonate (CO2).

Creatinine and BUN levels can reflect how well the kidneys are functioning. Sodium, potassium chloride, and calcium are electrolytes (charged minerals) that the body must keep in balance in the bloodstream. Bicarbonate reflects whether there is an imbalance in acid and base in the blood.

Severe abnormalities in these values can often indicate a medical emergency.

Comprehensive Metabolic Panel (CMP)

A comprehensive metabolic panel test is similar to a BMP, and it also includes protein, albumin (a type of protein), and liver function tests .

Lipid Panel

A lipid panel provides the count of triglycerides (a type of fat), low density lipoprotein (LDL) , high density lipoprotein (HDL) , and total cholesterol . Lipoproteins carry cholesterol , a waxy substance that is needed by the body but that can build up in blood vessels and cause problems.

These values reflect cardiovascular and stroke (a blockage of blood flow or bleeding in the brain) risk, with high levels of most lipid types usually associated with a high risk. However, low HDL (the so-called good cholesterol) levels are considered a risk factor for heart disease and stroke.

Other Blood Tests

Blood tests can be used to detect specific hormones, proteins, enzymes, or markers in the blood that are indicators of various conditions. These types of tests may be used to diagnose and monitor a condition, as well as evaluate treatments for the condition.

People often wonder why a variety of tubes are used to collect blood. Which are drawn depend on the test, as some need specific additives in the tube. More than one of the same type of tube may be drawn because they are being sent to different sections of the laboratory or to different laboratories.

Results for tests sent to a laboratory that performs specialized tests may take longer to be reported than for standard blood tests.

How Often Should You Get Blood Work Done?

Blood test frequency can vary. The types of blood tests you may need, and the collection schedule will depend. Factors may include if you have a chronic condition, are experiencing new systems, or need medical screening tests.

The cadence of blood work depends on the reason for the blood draw . This can include:

• Routine blood tests: Depending on your age and risk factors, you might need to have a lipid panel as part of standard health maintenance to determine whether your lipid levels could be putting you at risk of disease.
• Pregnancy: Blood work is used to monitor the pregnant person's blood glucose levels .
• Monitoring disease or response to treatment: Sometimes blood tests are needed at certain scheduled intervals to monitor disease or response to treatment. For example, suppose you are having treatment for systemic lupus erythematosus (SLE, the most common type of lupus). In that case, you might need periodic blood tests to monitor your white blood cell (WBC) count and erythrocyte sedimentation rate (ESR) . 
• Diagnosis: Blood tests may also be needed to help diagnose a suspected medical condition. For example, if you have unexplained weight gain, low energy, and have been feeling cold, you might need thyroid blood tests to determine your thyroid disease . 

Understanding Blood Test Results 

Usually, blood test results are reported as numbers. The value that’s being measured—such as calcium or hemoglobin—is compared to the standard or ideal value. 

The reported numbers from your blood test are not usually enough to make a diagnosis. You and your healthcare provider will need to discuss your overall health to put the numbers in perspective in terms of what they reflect about your health.

Awaiting Results

It can take hours, days, or longer for a blood test result to come back. If you are having an emergency blood test in a hospital, it might take less than an hour. It can take longer for results of specialized test results to come back.

How Does Your Blood Type Impact Overall Health?

Your blood type is one of the things that can be measured with a blood test. Blood type is designated by two types of markers—the ABO type and the Rh type. A blood typing test detects the presence or absence of these markers. The plus sign indicates Rh markers, while the minus sign indicates Rh-negative.

Blood types include: 

All these blood types are perfectly healthy. The significance of these blood types is that when you need a blood transfusion the blood given to you must be carefully matched to your type to avoid causing an immune reaction, which can be deadly.

Before transfusion, the recipient should be typed and their blood tested against the donor blood units (called a crossmatching test).

In general, donor blood that has A, B, or Rh+ markers can only be given to people with those same markers. Anyone can receive O- donor blood. However, outside of emergencies, it's preferred that type-specific, crossmatched blood be given.

Blood tests are used to measure different components of blood, and the measurements are an indication of health. You might need some blood tests as part of routine health maintenance, to assess certain symptoms, or to monitor disease progression and treatment. 

A Word From Verywell 

Getting a blood test is generally a simple procedure with very little risk. The process can be stressful, though, if you are afraid of needles or worried about test results.

Before a blood test, it can help to take a deep breath and stay calm and try to remember that the test isn’t harmful. Give yourself a chance to rest after your test for as long as you need to.

You can also ask how long it will take for results to come back. When you get your results back, you will be able to talk with your healthcare provider about what the results mean and what to consider as you decide on the next steps of treatment.

Colpo GD, Rocha NP, Furr Stimming E, Teixeira AL. Gene expression profiling in Huntington's Disease: does comorbidity with depressive symptoms matter? Int J Mol Sci. 2020;21(22):8474. doi:10.3390/ijms21228474

Bechtel L, Holstege CP. Utilizing the toxicology laboratory in the poisoned patient . Emerg Med Clin North Am . 2022;40(2):431-441. doi:10.1016/j.emc.2022.01.003

MedlinePlus. Kidney function tests .

MedlinePlus. CO2 blood test .

American Heart Association. HDL (good), LDL (bad) cholesterol and triglycerides .

Shin KH, Lee HJ, Oh SH, Jo SY, Lee SM, Kim IS. Sample collection for pre-transfusion crossmatching: benefits of using an electronic identification system . Transfus Med . 2022 Apr 2. doi:10.1111/tme.12863

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

Get health information you can use, fact-checked by Nebraska Medicine experts.

What blood tests should I get at my annual physical, and what do they mean?

In most instances, an annual exam is usually uneventful. Your doctor will ask how you’re feeling, perform a brief exam and may order some blood work. The results are posted in your electronic health records a few days later, or you may get a phone call to inform you that everything is normal. Many patients don’t give it another thought until the next physical rolls around.

But should you be paying more attention to the results of these tests?  And what blood tests should you be getting? There are some basic tests that most doctors will order annually or semiannually. Other more specialized tests depend on your family history, personal medical history and current health.

“That’s why it’s so important to have a relationship with a primary care provider,” says nurse practitioner Thomas Strawmier, APRN-NP .

“A provider that you see on a regular basis is going to have a good read on you and will be able to be more proactive in helping you stay healthy and preventing future health issues.”

Either way, it’s important to have a good conversation with your primary care provider about any new symptoms or health issues you’ve been having, in addition to any new insights about your family history. “These conversations will help your provider determine if there are tests above and beyond the basics that should be ordered,” notes Strawmier.

The following is a rundown of common lab tests your provider may order or tests you may want to request annually or at least every few years. 

Complete blood count (CBC)

A complete blood count is a standard blood test done at your annual physical that provides a picture of your blood. This includes a breakdown of your red blood cells, white blood cells, platelets, hemoglobin and hematocrit. High or low levels can provide insight into whether you are having issues with your bone marrow, immune system or if you’ve been affected by a virus or other environmental issues, says Strawmier.

Comprehensive metabolic panel (CMP)

This test reveals information about how your liver and kidneys are functioning and details about your electrolytes, potassium, sodium and calcium, which are indicators of whether you are dehydrated. It includes fasting blood glucose, which can be an indicator for predicting diabetes risk or blood sugar imbalances.

Hemoglobin A1C (HbA1C)

This is one of the best tests for getting information about blood sugar issues, insulin resistance and prediabetes. The higher your A1C, the higher the estimated blood glucose. An elevated A1C may indicate your body is not producing enough insulin (or your insulin isn’t working effectively) to move the glucose from the blood into your cells, a sign of prediabetes or diabetes.

Standard lipid panel

This measures your HDL (good) cholesterol, LDL (bad) cholesterol and triglycerides. A baseline should be done between the ages of 35 and 40 unless you have a family history of obesity or heart disease. Optimal levels include total cholesterol under 200, triglycerides under 150, an HDL of 39 to 60 and an LDL of 130 or below.

“A high LDL level increases your risk for heart disease,” says Strawmier. “If your HDL is elevated, you and your provider should discuss lifestyle changes to reduce your level and help prevent future heart disease.”

An advanced lipid panel is a test that might be considered for someone with an elevated cholesterol level or a genetic cholesterol issue.

Thyroid test

Your provider may want to order this test if you have high blood pressure or have complained of tiredness, lack of energy, focus or heart palpitations. Thyroid issues are fairly common, affecting 1 in 10 women. “This is a test I usually don’t order unless a patient complains of some of these symptoms or has a family history of thyroid disease,” says Strawmier.

Prostate screening (PSA)

A prostate-specific antigen test is recommended for all men by age 50 to check PSA levels. PSA is a protein made by the prostate gland. An elevated PSA may indicate prostate cancer, benign prostatic hyperplasia or BPH, or inflammation of the prostate.

 “If you are taking a vitamin D supplement, you probably don’t need your calcium levels checked,” says Strawmier. “This is not a common test I would order unless there are indications for it, such as chronic fatigue or depression.”

Individuals with long-term problems like rheumatoid arthritis should have their levels monitored because low vitamin D can reduce the effectiveness of treatment, he says.  

Anemia panel

This is a test you may want to consider if you have chronic fatigue, lack of energy, heavy menstrual cycles, or if you have had any stomach issues such as gastric bypass or absorption difficulties, notes Strawmier.

An anemia panel tests for key nutrients such as iron, ferritin, folate and vitamin B12. Low vitamin B12 is more common among vegans and vegetarians. People with malabsorption issues due to antibiotic overuse, celiac or Crohn’s disease may also have low B12 levels. Folate is important in women who are pregnant or trying to conceive as it helps protect against congenital disabilities. Menstruating women, especially those with heavy periods, may be at risk for low iron levels. It’s also interesting to note that you can still have low iron levels even if you're not anemic.

After your labs are completed

When your labs come back, your provider will review them and look for potential issues. If they see a red flag, an additional test may be needed. If there are no issues, you may receive a phone call from your provider’s office, or the lab results will be posted in your One|Chart Patient portal with corresponding notes for you to review at your convenience.

Before you leave your annual physical, it is important to discuss with your provider how you would like to do a follow up on your labs. This might include a phone call from office staff, a telehealth visit or posting them to your electronic records.

“Maintaining a regular primary care provider, staying current on your annual physicals and having an open and honest relationship with your provider will go a long way in helping you stay healthy and be proactive in your health,” says Strawmier. 

Need a primary care provider? Use the online scheduling tool or call 800.922.0000 to schedule an appointment with a primary care provider that fits your needs and is close to home.

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What Happens During a Wellness Visit?

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Jose Luis Pelaez / Getty Images

Importance of a Wellness Visit

• What to Expect
• How to Prepare

A wellness visit is a health check-up that is typically conducted on an annual basis. It involves visiting your healthcare provider to check your vitals, screen for health conditions , and develop a healthcare plan for your needs.

The aim of a wellness visit is to promote health and prevent disease and disability.

This article explains why annual wellness visits are important, what you can expect during the process, and how to prepare for it.

These are some reasons why wellness visits are important.

Prevent Diseases

Most healthcare visits are categorized under diagnostic care; when you have a health problem, you visit a healthcare provider who assesses your symptoms, diagnoses your condition, and prescribes a treatment plan.

A wellness visit on the other hand is a preventative healthcare measure. The aim of preventative healthcare is to help you maintain good health and prevent health problems before they develop. The goal is to help you live a longer, healthier life.

Wellness visits assess your lifestyle, evaluate health risks, and screen for health conditions, in order to prevent health problems or catch them in the early stages. Instead of waiting to see a healthcare provider once you have a health problem, the idea is to be proactive about your health and work with your healthcare provider to prevent health problems.

People tend to think that it’s fine to skip their annual wellness visit if they’re feeling healthy. However, a 2021 study notes that wellness visits can play a role in catching chronic health conditions early, as well as helping people control for risk factors that could cause them to develop health issues down the line.

Reduce Medical Costs

Wellness visits can help prevent disease and disability, which in turn can help reduce medical costs. According to a 2016 study, a focus on preventive healthcare can significantly reduce medical costs and improve the quality of healthcare services.

What to Expect During a Wellness Visit

A wellness visit may be performed by a healthcare provider such as a doctor, nurse practitioner, clinical nurse specialist, physician assistant, or other qualified health professional.

These are some of the steps a wellness visit may involve:

• Family history: Your healthcare provider may ask you detailed questions about your family’s medical history, to determine whether you are at an increased risk for certain health conditions that may be passed on genetically .
• Medical history: You may also be asked questions about your personal medical history. It can include information about any current or previous diseases, allergies, illnesses, surgeries, accidents, medications, vaccinations, and hospitalizations, as well as the results of any medical tests and examinations.
• Measurements: Your healthcare provider may measure your height, weight, heart rate, blood pressure, and other vital signs. Doing this regularly can help you establish a baseline as well as track any changes in your health.
• Cognitive assessment: Your healthcare provider may assess your ability to think, remember, learn, and concentrate, in order to screen for conditions such as Alzhemer’s disease and dementia.
• Mental health assessment: Your healthcare provider may also assess your mental health and state of mind, to help screen for conditions such as depression and other mood disorders.
• Physical assessment: Your healthcare provider may perform a physical examination to check your reflexes. They may also perform a neurological exam, a head and neck exam, an abdominal exam, or a lung exam.
• Functional assessment: Your healthcare provider may assess your hearing, your vision, your ability to perform day-to-day tasks, your risk of falling, and the safety of your home environment.
• Lifestyle factors: Your healthcare provider may ask you questions about your nutrition, fitness, daily habits, work, stress levels, and consumption of substances such as tobacco, nicotine, alcohol, and drugs.
• Health risk assessment: Based on this information, your healthcare provider will evaluate your health, and determine whether you are at an increased risk for any health conditions.
• Health advice: Your healthcare provider may advise you on steps you can take to improve your health, control risk factors, and prevent disease and disability. This may include nutrition counseling, an exercise plan, flu shot and vaccination recommendations, and fall prevention strategies, among other things.
• Screenings: Your healthcare provider may recommend that you get screened for certain health conditions such as depression , cholesterol, blood pressure, diabetes, cancer, heart disease, or liver conditions. This may involve blood work, imaging scans, or other screening tests. 
• Medication review: Your healthcare provider may review your medication and adjust it, if required. This can include prescription medication, over-the-counter medication, vitamins, supplements, and herbal or traditional medication.
• Referrals and resources: If required, your healthcare provider will provide a referral to other healthcare specialists. They can also provide other resources that may be helpful, such as counseling services or support groups , for instance.
• Medical providers: Your healthcare provider will work with you to create or update a list of your current medical providers and equipment suppliers. This list can be helpful in case of an emergency.
• Healthcare plan: Your healthcare provider will work with you to create a healthcare plan that is tailored to your needs. The plan will serve as a checklist that will list any screenings or preventive measures you need to take over the next five to 10 years.

The screenings, assessments, and healthcare plan can vary depending on factors such as your age, gender, lifestyle, and risk factors.

How to Prepare for a Wellness Visit

These are some steps that can help you prepare for a wellness visit:

• Fill out any required questionnaires: Your healthcare provider may ask you to fill out a questionnaire before your visit. The questionnaire may include some of the factors listed above. Make sure you do it before your visit, so that you can make the most of your time with your healthcare provider.
• Carry your medications: If possible, try to carry your medications with you to show them to your healthcare provider.
• Take your medical documents along: It can be helpful to carry your prescriptions, immunization records, as well as the results of any medical tests or screenings you have had, to help give your healthcare provider a more accurate picture of your health status.
• Ask someone to go with you: You may want to take a trusted friend or family member along with you for the wellness visit. They can assist you if required, take notes for you, ask questions, and help you remember your healthcare provider’s instructions.
• Note down questions and concerns: A wellness visit is a good opportunity to ask your healthcare provider any questions you have about your health and tell them about any health problems or concerns you have. Making a list and carrying it with you to the visit can help ensure that you don’t miss anything.
• Check your insurance plan: Most insurance plans cover wellness visits; however, what is covered as part of the wellness visit can vary depending on the plan. It can be helpful to know what preventative services and wellness visits your plan offers. It’s important to check that your healthcare provider takes your insurance and to inform them that you’ll be coming for a wellness visit when you schedule your appointment.

A Word From Verywell

A wellness visit can help you evaluate your health status, understand your risk for specific health conditions, and give you the information and resources you need to improve your health.

After you go for a wellness visit, it’s important that you start implementing your healthcare provider’s advice, take any follow-up appointments necessary, and take steps to improve your health.

U.S. Department of Health and Human Services. Get your wellness visit every year .

University Hospitals. What you need to know about wellness visits .

Liss DT, Uchida T, Wilkes CL, Radakrishnan A, Linder JA. General health checks in adult primary care: a review . JAMA . 2021;325(22):2294-2306. doi:10.1001/jama.2021.6524

Musich S, Wang S, Hawkins K, Klemes A. The impact of personalized preventive care on health care quality, utilization, and expenditures . Popul Health Manag . 2016;19(6):389-397. doi:10.1089/pop.2015.0171

Alzheimer’s Association. Annual wellness visit .

University of Michigan Health. Your yearly wellness visit .

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Your Medicare annual wellness visit: Preventive care, health planning at no extra cost

Most of us know that it’s important to see a doctor for an annual checkup. During your working years, that annual checkup typically means a full physical. But once you become eligible for Medicare, you’ll likely start hearing about something called an  annual wellness visit .

Unlike a standard head-to-toe physical, an annual wellness visit is primarily focused on preventive care, health screenings and wellness planning. It gives you an opportunity to have a conversation with your doctor about your health status and goals – then create a long-term plan to help you meet those goals and maximize your well-being.

While Original Medicare doesn’t cover an annual physical, some Medicare Advantage plans do. However, everyone enrolled in Original Medicare or Medicare Advantage is eligible for an annual wellness visit at no additional cost.  If your Medicare Advantage plan includes coverage for an annual comprehensive physical exam, ask your provider if the annual wellness visit and the physical can be scheduled during the same visit.

Below you’ll find an overview of what to expect from your annual wellness visit – and hopefully the motivation to schedule one.

Taking stock of your medical history

Your primary care provider , whether in person or virtually , will review your relevant medical history, including major illnesses, surgeries, plus any current medical conditions and medications you’re taking.

Your doctor’s office may send you a form ahead of your appointment that includes a list of questions. 

To-do : Fill out this form in advance to help ensure your doctor has a thorough understanding of your health history. It may also remind you of questions you might want to raise at the appointment.

If you don’t get a form before your visit, you should still be prepared to be as detailed as possible when describing any past medical procedures and illnesses. Knowing specific diagnoses and dates will certainly help, but even giving a rough description of any major medical events in your life will help your physician understand both your past and current medical issues.

The who’s who of your health care team

Keeping you healthy is a group effort, and the primary care provider you see for your wellness visit will want to know who’s part of your health care team. He or she may also want to work closely with other health care professionals involved in your care.

To-do : Be prepared to give the person conducting your visit a list of your current health care providers, including contact information and fields of specialty.

If you see several specialists to help you manage chronic conditions or haven’t seen some of your doctors in the past year, it can be easy to forget their names. That’s why it’s a good idea to create a list of your doctors and bring it with you to your wellness visit.

You may have chosen a health care surrogate or a proxy who will speak on your behalf should you ever become too sick to speak for yourself. If so, bring a copy of your completed forms to your appointment. If you haven’t made your choices yet, this is a good time to get your physician’s advice on your personal advance care planning .

An Rx for a productive medication review

Getting a full rundown of all your vitamins, minerals, herbal supplements and prescription medications can help the doctor spot potential drug interactions that could be harmful to your health. He or she will also want to ensure you have a complete understanding   of each medication, its purpose and any potential side effects.

To-do: Make a list, including how often you take each medication and the dosage. Or, bring all your pill bottles with you to your appointment and show them to the provider.

Stats and screenings

A clinician will check your height, weight and blood pressure, and then your provider will likely ask you some questions, including how you have been feeling recently. These questions are designed to test your cognitive function and screen you for depression. Answer them as honestly as possible and come to the appointment well-rested so you can perform your best on the tests.

Creating a wellness plan

After completing all tests and assessments, your provider will be ready to assess your current health status and work with you to develop a plan to meet your health goals. That plan will address how to treat your current conditions and how to help prevent future health problems. If you have any risk factors for developing new conditions, your provider will give you some options for managing those risks.

You can also set up a schedule for preventive care or screening tests and discuss treatment options for any newly diagnosed conditions.

To-do : Be prepared to get the most out of this planning by developing a list of questions you would like to ask at the appointment. And don’t be shy with your questions. During the annual wellness visit, your provider may have more time than usual to listen to your concerns and answer your questions.

It’s also important to be honest about your health goals. Not everyone sets out to exercise daily or lose 10 pounds in the next year – and that’s OK. Maybe your goal is to ride a bike with your grandkids around the neighborhood or to cut back on your alcohol consumption. Whatever your health goals are, your provider can’t help you reach them if he or she doesn’t know about them. So be as open and honest as possible during your visit.

Things to keep in mind

To avoid surprises, pay attention to these details as you get your visit on the calendar:

• Make sure the appointment is scheduled specifically as an annual wellness visit, or the provider may bill it as a normal office visit, which could be subject to a copay, depending on your plan. If you’re a UnitedHealthcare member, our dedicated customer service advocates can even help schedule your appointment for you.
• If your provider orders a test during the annual wellness visit, you may be charged any applicable lab or diagnostic copay for the recommended services.

When you are prepared, your annual wellness visit is more than just an office visit. It is your opportunity to take charge of your health and help ensure you’re on the right path to living the life you want. If you haven’t scheduled yours yet, use this as the push you need to get it on your calendar. It could be one of the most important conversations you have all year.

To learn more about how your how your UnitedHealthcare Medicare plan can help you access the care you need, visit UHCMedicareHealthPlans.com .

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How To Get the Most Accurate Blood Test Results

January 20, 2022

A blood test may not be the most pleasant experience in the world, but it is an important part of your overall health plan. There’s a lot your doctor can tell about your health from that little vial of blood. It works somewhat like a crystal ball, but what you do in the hours before could have a negative effect on your blood test results.

The  National Institutes of Health  remind us that blood tests help doctors check for certain diseases and conditions. They also help check the function of your organs and show how well treatments are working.

Specifically, blood tests can help doctors:

• Evaluate how well your organs are working
• Diagnose diseases and conditions such as cancer, HIV/AIDS, diabetes, anemia and coronary heart disease
• Find out whether you have risk factors for heart disease
• Check whether medicines you're taking are working
• Assess how well your blood is clotting

Blood tests are very common and have minimal risk. But there are some things that you can do just before the test that can affect the outcome, says Robert Krajcik, MD , a family medicine specialist with UH Ohio Medical Group.

Here are some of the things Dr. Krajcik recommends that you should do, or avoid, to get the most accurate blood test results.

For Accurate Blood Test Results: Fast

Most people are familiar with having to fast before a blood test. There is good reason your doctor recommends not eating or drinking: to attain the most accurate blood test results.

Nutrients and ingredients in the food and beverages you eat and drink are absorbed into your bloodstream. This could impact factors measured by certain tests. Fasting improves the accuracy of those tests, Dr. Krajcik says.

Blood tests that you will likely need to fast for include:

• Blood glucose test
• Cholesterol test (total, HDL, LDL)
• Triglyceride level test

“Fasting ensures your blood test results will not be influenced by foods you eat in the hours before your blood is drawn,” Dr. Krajcik says. “The results could be affected because the food may not be fully absorbed by your body. You must give it eight to 12 hours to digest.”

Water Does Not Impact Blood Test Results

Some tests will require you to eat nothing at all, but in most cases, you will be allowed to drink water. Water can actually help with the blood test Dr. Krajcik says.

“Blood is roughly 50 percent water, and the water you drink hydrates your veins,” he says. Water plumps the veins up, making it easier for the technician to find them, and, as a result, making for a smoother blood draw. Water will also help keep your blood pressure from dropping.

Ask your doctor what you’re allowed to drink before your test.

Don’t Exercise For Accurate Blood Test Results

This may be the only time in your life your doctor may tell you not to exercise. A workout can negatively impact blood test results. For the most accurate blood test results, your blood should be drawn when you’re rested, Dr. Krajcik says.

A workout before a fasting blood test can alter the results of cholesterol and glucose tests. “In some cases of cholesterol testing, if you exercise before having blood drawn, your LDL cholesterol levels may actually increase,” he says. “This is the bad cholesterol that you want to keep low.”

Although exercise improves an overall blood panel, strenuous physical exercise before a blood draw may negatively impact the results, so hold off on that workout until you’re done.

Alcohol Could Affect Blood Test Results

In general, alcohol the night before should not affect your blood test results, Dr. Krajcik says. If you begin fasting 12 hours before the test (including alcohol), it will most likely be metabolized, as long as you keep it to a drink or two.

However, if the panel is specific to your liver enzymes, they may be altered. Your best bet is to ask your doctor, or when in doubt, just leave it out.

Medications and Blood Test Results

The first rule of medications and blood test results is to talk to your doctor about what medicines you’re taking before your blood draw. You should also mention it to the person who is drawing your blood, so they can make a note of it, too.

You should never stop taking a prescription unless your doctor tells you.

Some medicines can affect blood test results, but this doesn't necessarily mean you should stop taking your medicine. Steroids, for example, can increase your cholesterol levels, but your doctor can take this into account when reading your results.

Vitamins, supplements, and even herbal remedies can also affect results, so if you’re taking any of these you should tell your doctor.

Smoking Affects Blood Test Results

To get the most accurate blood test results you should not smoke.

There have yet to be any strong clinical studies on the effect of e-cigarettes on blood sugar levels of people with diabetes, but  research shows  higher nicotine levels are associated with slightly increased HbA1c levels in people without diabetes.

In general, if you’ve been asked to fast before your blood test, you should avoid smoking, too.

Routine Blood Tests Are a Good Idea

Even if you feel healthy, it’s still a good idea to get a regular blood test. Your blood test results can tell you a lot about your health, Dr. Krajcik says. The results will alert you to potential problems, or may spur you to consider some healthy lifestyle changes.

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How often do i need routine blood work.

Table of Contents

As adults, when we see our primary care provider for check-ups, it usually means rolling up our sleeves. Blood work is a part of most well visits, even when we’re healthy. But what are doctors looking for? And how often do we need to get blood drawn?

What Are We Looking For With Routine Blood Work?

• A Complete Blood Count (CBC) checks red blood cells, white blood cells, and platelets. A CBC can identify conditions including anemia, heart disease, autoimmune disease, leukemia, and other cancers.
• A Basic Metabolic Panel (BMP) checks kidney function, lung function, and blood sugar levels by testing blood filtration, blood sugar, and electrolyte levels. This test can identify common kidney problems, lung problems, and diabetes or pre-diabetes.
• A Complete Metabolic Panel covers the tests included in a BMP with additional tests related to liver function.
• A Lipid Panel checks for cholesterol and triglycerides in the blood and can detect the buildup of plaque in your arteries. This test is an important early screening for coronary artery disease.

Some other frequently ordered tests include:

• Nutrient tests for levels of certain minerals or vitamins: iron and vitamins D and B12 are low in many adults.
• A Thyroid Panel checks the thyroid gland, which regulates crucial hormones and can impact mood, energy level, and metabolism.
• For patients with diabetes, a hemoglobin A1C test offers a more accurate overall picture of blood sugar than basic glucose tests.

What Should I Expect When I Get Bloodwork?

Your doctor may recommend a CBC and BMP every year at your annual well visit. Other tests depend on your age, lifestyle and personal and family history. In most cases, your primary care provider will ask you to fast for 12 hours before your blood draw. This helps avoid fluctuations in blood sugar and other chemical changes that result from eating and drinking. Your primary care practice staff will fill a separate vial for each panel, but often only one needle is required. Your doctor’s office sends samples to a lab and usually gets results in a few days. If one of your baseline blood work tests shows abnormal results, the next step is further testing.

Are Blood Work Recommendations Different for Women and Men?

Most of the baseline blood work tests are the same for women and men. However, timing and needed tests may vary based on sex. For example, men are at greater risk for high cholesterol, so they may need lipid testing earlier than women. Thyroid disorders and low Vitamin D levels are more common in women, so your doctor may recommend adding those to your well visit under certain circumstances.

Does Blood Work Change As We Age?

Many blood tests are the same for all adults, but some may be ordered more frequently as we age. For example, a lipid panel every five years is sufficient for younger adults (unless you have a family history of high cholesterol). However, your doctor may increase testing frequency as you reach your 40s or 50s. Doctors also order thyroid panels more frequently for older adults. Some other blood tests that are common for seniors include:

• PT/INR blood clotting tests for seniors on blood thinners
• BNP peptide tests for heart function
• Ferritin tests for iron levels
• Vitamin levels including B12

On the flip side, your doctor may be more likely to recommend HIV and other tests for sexually transmitted diseases for sexually active young adults.

Routine Blood Work and Primary Care

Understanding each individual’s needs is at the core of patient-centered medicine. Just like in-person or telemedicine visits with your primary care provider, routine blood work helps us understand you and your body. Blood work helps us establish a baseline for essential functions and then follow-up regularly. At Comprehensive Primary Care, we want to make sure everything is on track and catch any potential issues early. We don’t need to perform every single test every year, but some tests are best done annually for consistency. We understand that some patients avoid check-ups because of anxiety. But the best way to prevent stress about doctor visits is to make routine care truly routine, with a focus on wellness. So let’s roll up those sleeves and stay healthy together.

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Medicare Wellness Visits Back to MLN Print November 2023 Updates

What’s Changed?

• Added information about monthly chronic pain management and treatment services
• Added information about checking for cognitive impairment during annual wellness visits
• Added information about Social Determinants of Health Risk Assessments as an optional element of annual wellness visits

Quick Start

The Annual Wellness Visits video helps you understand these exams, as well as their purpose and claim submission requirements.

Medicare Physical Exam Coverage

Initial Preventive Physical Exam (IPPE)

Review of medical and social health history and preventive services education.

✔ New Medicare patients within 12 months of starting Part B coverage

✔ Patients pay nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)

Visit to develop or update a personalized prevention plan and perform a health risk assessment.

✔ Covered once every 12 months

Routine Physical Exam

Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.

✘ Medicare doesn’t cover a routine physical

✘ Patients pay 100% out-of-pocket

Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health :

• Health Equity Technical Assistance Program
• Disparities Impact Statement

Communication Avoids Confusion

As a health care provider, you may recommend that patients get services more often than we cover or that we don’t cover. If this happens, help patients understand they may have to pay some or all costs. Communication is key to ensuring patients understand why you’re recommending certain services and whether we cover them.

Initial Preventive Physical Exam

The initial preventive physical exam (IPPE), also known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it’s provided within the first 12 months after the patient’s Part B coverage starts.

1. Review the patient’s medical and social history

At a minimum, collect this information:

• Past medical and surgical history (illnesses, hospital stays, operations, allergies, injuries, and treatments)
• Current medications, supplements, and other substances the person may be using
• Family history (review the patient’s family and medical events, including hereditary conditions that place them at increased risk)
• Physical activities
• Social activities and engagement
• Alcohol, tobacco, and illegal drug use history

Learn information about Medicare’s substance use disorder (SUD) services coverage .

2. Review the patient’s potential depression risk factors

Depression risk factors include:

• Current or past experiences with depression
• Other mood disorders

Select from various standardized screening tools designed for this purpose and recognized by national professional medical organizations. APA’s Depression Assessment Instruments has more information.

3. Review the patient’s functional ability and safety level

Use direct patient observation, appropriate screening questions, or standardized questionnaires recognized by national professional medical organizations to review, at a minimum, the patient’s:

• Ability to perform activities of daily living (ADLs)
• Hearing impairment
• Home and community safety, including driving when appropriate

Medicare offers cognitive assessment and care plan services for patients who show signs of impairment.

• Height, weight, body mass index (BMI) (or waist circumference, if appropriate), blood pressure, balance, and gait
• Visual acuity screen
• Other factors deemed appropriate based on medical and social history and current clinical standards

5. End-of-life planning, upon patient agreement

End-of-life planning is verbal or written information you (their physician or practitioner) can offer the patient about:

• Their ability to prepare an advance directive in case an injury or illness prevents them from making their own health care decisions
• If you agree to follow their advance directive
• This includes psychiatric advance directives

6. Review current opioid prescriptions

For a patient with a current opioid prescription:

• Review any potential opioid use disorder (OUD) risk factors
• Evaluate their pain severity and current treatment plan
• Provide information about non-opiod treatment options
• Refer to a specialist, as appropriate

The HHS Pain Management Best Practices Inter-Agency Task Force Report has more information. Medicare now covers monthly chronic pain management and treatment services .

7. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them to treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

8. Educate, counsel, and refer based on previous components

Based on the results of the review and evaluation services from the previous components, provide the patient with appropriate education, counseling, and referrals.

9. Educate, counsel, and refer for other preventive services

Include a brief written plan, like a checklist, for the patient to get:

• A once-in-a-lifetime screening electrocardiogram (ECG), as appropriate
• Appropriate screenings and other covered preventive services

Use these HCPCS codes to file IPPE and ECG screening claims:

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv

* Section 60.2 of the Medicare Claims Processing Manual, Chapter 9 has more information on how to bill HCPCS code G0468.

Report a diagnosis code when submitting IPPE claims. We don’t require you to use a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an IPPE when performed by a:

• Physician (doctor of medicine or osteopathy)
• Qualified non-physician practitioner (physician assistant, nurse practitioner, or certified clinical nurse specialist)

When you provide an IPPE and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

CPT only copyright 2022 American Medical Association. All rights reserved.

IPPE Resources

• 42 CFR 410.16
• Section 30.6.1.1 of the Medicare Claims Processing Manual, Chapter 12
• Section 80 of the Medicare Claims Processing Manual, Chapter 18
• U.S. Preventive Services Task Force Recommendations

No. The IPPE isn’t a routine physical that some patients may get periodically from their physician or other qualified non-physician practitioner (NPP). The IPPE is an introduction to Medicare and covered benefits, and it focuses on health promotion, disease prevention, and detection to help patients stay well. We encourage providers to inform patients about the AWV during their IPPE. The Social Security Act explicitly prohibits Medicare coverage of routine physical exams.

No. The IPPE and AWV don’t include clinical lab tests, but you may make appropriate referrals for these tests as part of the IPPE or AWV.

No. We waive the coinsurance, copayment, and Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening electrocardiogram (ECG) (HCPCS codes G0403, G0404, or G0405).

A patient who hasn’t had an IPPE and whose Part B enrollment began in 2023 can get an IPPE in 2024 if it’s within 12 months of the patient’s Part B enrollment effective date.

We suggest providers check with their MAC for available options to verify patient eligibility. If you have questions, find your MAC’s website .

Annual Wellness Visit Health Risk Assessment

The annual wellness visit (AWV) includes a health risk assessment (HRA). View the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments has more information, including a sample HRA.

Perform an HRA

• You or the patient can update the HRA before or during the AWV
• Consider the best way to communicate with underserved populations, people who speak different languages, people with varying health literacy, and people with disabilities
• Demographic data
• Health status self-assessment
• Psychosocial risks, including, but not limited to, depression, life satisfaction, stress, anger, loneliness or social isolation, pain, suicidality, and fatigue
• Behavioral risks, including, but not limited to, tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (for example, seat belt use), and home safety
• Activities of daily living (ADLs), including dressing, feeding, toileting, and grooming; physical ambulation, including balance or fall risks and bathing; and instrumental ADLs (IADLs), including using the phone, housekeeping, laundry, transportation, shopping, managing medications, and handling finances

1. Establish the patient’s medical and family history

At a minimum, document:

• Medical events of the patient’s parents, siblings, and children, including hereditary conditions that place them at increased risk
• Use of, or exposure to, medications, supplements, and other substances the person may be using

2. Establish a current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including behavioral health care.

• Height, weight, body mass index (BMI) (or waist circumference, if appropriate), and blood pressure
• Other routine measurements deemed appropriate based on medical and family history

4. Detect any cognitive impairments the patient may have

Check for cognitive impairment as part of the first AWV.

Assess cognitive function by direct observation or reported observations from the patient, family, friends, caregivers, and others. Consider using brief cognitive tests, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Alzheimer’s and Related Dementia Resources for Professionals has more information.

5. Review the patient’s potential depression risk factors

6. Review the patient’s functional ability and level of safety

• Ability to perform ADLs

7. Establish an appropriate patient written screening schedule

Base the written screening schedule on the:

• Checklist for the next 5–10 years
• United States Preventive Services Task Force and Advisory Committee on Immunization Practices (ACIP) recommendations
• Patient’s HRA, health status and screening history, and age-appropriate preventive services we cover

8. Establish the patient’s list of risk factors and conditions

• A recommendation for primary, secondary, or tertiary interventions or report whether they’re underway
• Mental health conditions, including depression, substance use disorders , suicidality, and cognitive impairments
• IPPE risk factors or identified conditions
• Treatment options and associated risks and benefits

9. Provide personalized patient health advice and appropriate referrals to health education or preventive counseling services or programs

Include referrals to educational and counseling services or programs aimed at:

• Fall prevention
• Physical activity
• Tobacco-use cessation
• Social engagement
• Weight loss

10. Provide advance care planning (ACP) services at the patient’s discretion

ACP is a discussion between you and the patient about:

• Preparing an advance directive in case an injury or illness prevents them from making their own health care decisions
• Future care decisions they might need or want to make
• How they can let others know about their care preferences
• Caregiver identification
• Advance directive elements, which may involve completing standard forms

Advance directive is a general term that refers to various documents, like a living will, instruction directive, health care proxy, psychiatric advance directive, or health care power of attorney. It’s a document that appoints an agent or records a person’s wishes about their medical treatment at a future time when the individual can’t communicate for themselves. The Advance Care Planning fact sheet has more information.

We don’t limit how many times the patient can revisit the ACP during the year, but cost sharing applies outside the AWV.

11. Review current opioid prescriptions

• Review any potential OUD risk factors
• Provide information about non-opioid treatment options

12. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them for treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

13. Social Determinants of Health (SDOH) Risk Assessment

Starting in 2024, Medicare includes an optional SDOH Risk Assessment as part of the AWV. This assessment must follow standardized, evidence-based practices and ensure communication aligns with the patient’s educational, developmental, and health literacy level, as well as being culturally and linguistically appropriate.

1. Review and update the HRA

2. Update the patient’s medical and family history

At a minimum, document updates to:

3. Update current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including those added because of the first AWV personalized prevention plan services (PPPS), and any behavioral health providers.

• Weight (or waist circumference, if appropriate) and blood pressure

5. Detect any cognitive impairments patients may have

Check for cognitive impairment as part of the subsequent AWV.

6. Update the patient’s written screening schedule

Base written screening schedule on the:

7. Update the patient’s list of risk factors and conditions

• Mental health conditions, including depression, substance use disorders , and cognitive impairments
• Risk factors or identified conditions

8. As necessary, provide and update patient PPPS, including personalized health advice and appropriate referrals to health education or preventive counseling services or programs

9. Provide advance care planning (ACP) services at the patient’s discretion

10. Review current opioid prescriptions

11. Screen for potential substance use disorders (SUDs)

12. Social Determinants of Health (SDOH) Risk Assessment

Preparing Eligible Patients for their AWV

Help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:

• Medical records, including immunization records
• Detailed family health history
• Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
• Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists

Use these HCPCS codes to file AWV claims:

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Report a diagnosis code when submitting AWV claims. We don’t require you to use a specific AWV diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an AWV if performed by a:

• Medical professional (including health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals directly supervised by a physician

When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs. Don’t bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. We deny these claims with messages indicating the patient reached the benefit maximum for the time period.

Medicare telehealth includes HCPCS codes G0438 and G0439.

ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a patient to discuss their health care wishes and medical treatment preferences if they become unable to communicate or make decisions about their care. At the patient’s discretion, you can provide the ACP during the AWV.

Use these CPT codes to file ACP claims as an optional AWV element:

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Report a diagnosis code when submitting an ACP claim as an optional AWV element. We don’t require you to use a specific ACP diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

We waive both the Part B ACP coinsurance and deductible when it’s:

• Provided on the same day as the covered AWV
• Provided by the same provider as the covered AWV
• Billed with modifier 33 (Preventive Service)
• Billed on the same claim as the AWV

We waive the ACP deductible and coinsurance once per year when billed with the AWV. If we deny the AWV billed with ACP for exceeding the once-per-year limit, we’ll apply the ACP deductible and coinsurance .

We apply the deductible and coinsurance when you deliver the ACP outside the covered AWV. There are no limits on the number of times you can report ACP for a certain patient in a certain period. When billing this service multiple times, document changes in the patient’s health status or wishes about their end-of-life care.

SDOH is important in assessing patient histories; in assessing patient risk; and in guiding medical decision making, prevention, diagnosis, care, and treatment. In the CY 2024 Medicare Physician Fee Schedule final rule , we added a new SDOH Risk Assessment as an optional, additional element of the AWV. At both yours and the patient’s discretion, you may conduct the SDOH Risk Assessment during the AWV.

Use this HCPCS code to file SDOH Risk Assessment claims as an optional AWV element:

Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes

Report a diagnosis code when submitting an SDOH Risk Assessment claim as an optional AWV element. We don’t require you to use a specific SDOH Risk Assessment diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

The implementation date for SDOH Risk Assessment claims is July 1, 2024. We waive both the Part B SDOH Risk Assessment coinsurance and deductible when it’s:

We waive the SDOH Risk Assessment deductible and coinsurance once per year when billed with the AWV.

If we deny the AWV billed with SDOH Risk Assessment for exceeding the once-per-year limit, we’ll apply the deductible and coinsurance. We also apply the deductible and coinsurance when you deliver the SDOH Risk Assessment outside the covered AWV.

AWV Resources

• 42 CFR 410.15
• Section 140 of the Medicare Claims Processing Manual, Chapter 18

No. The AWV isn’t a routine physical some patients may get periodically from their physician or other qualified NPP. We don’t cover routine physical exams.

No. We waive the coinsurance, copayment, and Part B deductible for the AWV.

We cover an AWV for all patients who’ve had Medicare coverage for longer than 12 months after their first Part B eligibility date and who didn’t have an IPPE or AWV within those past 12 months. We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient’s last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.

Generally, you may provide other medically necessary services on the same date as an AWV. The deductible and coinsurance or copayment applies for these other medically necessary and reasonable services.

You have different options for accessing AWV eligibility information depending on where you practice. Check eligibility to find when a patient is eligible for their next preventive service. Find your MAC’s website if you have specific patient eligibility questions.

Know the Differences

An IPPE is a review of a patient’s medical and social health history and includes education about other preventive services .

• We cover 1 IPPE per lifetime for patients within the first 12 months after their Part B benefits eligibility date
• We pay IPPE costs if the provider accepts assignment

An AWV is a review of a patient’s personalized prevention plan of services and includes a health risk assessment.

• We cover an annual AWV for patients who aren’t within the first 12 months after their Part B benefits eligibility date
• We cover an annual AWV 12 months after the last AWV’s (or IPPE’s) date of service
• We pay AWV costs if the provider accepts assignment

A routine physical is an exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.

• We don’t cover routine physical exams, but the IPPE, AWV, or other Medicare benefits cover some routine physical elements
• Patients pay 100% out of pocket

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CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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What to Expect at Your Annual Wellness Visit

Once a year, you make an appointment with your primary care physician to make sure your health is in good working order and detect potential concerns early, before symptoms are noticeable.

To schedule your annual wellness or follow-up office visit with a provider in Primary Care, please visit here or login to Connect .

Most insurance plans cover your annual wellness exam — no copay required. However, you may find the actual components of a wellness visit a bit confusing.

Review the FAQs below to learn what to expect during your next annual wellness visit.

Frequently Asked Questions

What is included in a wellness visit.

Your annual wellness visit includes the following:

• A review of your medical and surgical history
• Screenings - we generally follow screening recommendations of the USPSTF
• Blood tests
• Immunizations - we follow the vaccine schedules published by the CDC
• A physical exam
• Counseling to prevent future health problems 

How should I prepare for my visit?

Please check in via Connect up to 5 days before your visit to make sure we have your most up-to-date information, including your medications, medical history and insurance. You will be able to update these, along with your preferred pharmacy. You can also review and update your responses to your health questionnaire.

Please fast for at least 4 hours prior to your visit. You may drink water or black coffee, and take your maintenance medications.  Pediatric and Gynecology patients should not fast.

On the day of your appointment, please arrive on time and bring your insurance card and ID.

What if I need to ask my doctor about a specific medical issue?

Specific issues are considered part of a follow-up or “sick” visit. These aspects of your visit will be billed to your insurance, and you may be responsible for copayments, coinsurance or deductible payments, based on the terms of your policy.

If you would like to address non-routine concerns during your wellness visit, you can let your doctor know about these issues when you schedule your appointment. Depending on their complexity, the questions may need to be dealt with at a later time.

What does a follow-up or “sick” visit include?

• Treatment of a chronic condition such as diabetes, asthma or high blood pressure
• Any new problems or complaints
• Your need for new medications or tests
• Referrals to a specialist
• Additional treatment options

What is a Medicare annual wellness visit and what does it include?

The Medicare annual wellness visit, covered by Medicare, allows your health-care provider to conduct a health risk assessment and propose screenings and prevention strategies. As well, your provider will make sure all your immunizations, cancer screenings and other screenings are discussed and scheduled.

Your Medicare wellness visit does not include a detailed physical exam or management of chronic or new medical problems . Your physician may be able to perform a complete physical and address new or existing medical issues during your Medicare annual wellness visit, but you could incur additional charges.

What to expect during your Medicare annual wellness visit

At your Medicare annual wellness visit, your health care provider will:

• Review your blood pressure, heart rate, height, weight and body mass index (BMI).
• Review your current health problems, as well as your medical, surgical, family and social histories.
• Review your current medications.
• Conduct a health risk assessment.
• Provide nutrition counseling.
• Discuss an exercise plan to fit your lifestyle.
• Discuss smoking cessation and arrange for counseling, if needed.
• Discuss fall prevention.
• Discuss advance care planning.
• Discuss preventive screenings recommended by evidence-based practice guidelines that are indicated for you based upon your age, risk factors and family history

How to prepare for your Medicare wellness visit

Bring these items to your visit:

• Immunization records
• A list of current prescribed medicines, supplements and over-the-counter medications
• A list of your patient care team—any specialists you see for various types of care
• Be prepared to review your family medical history.

Can I combine a Medicare or non-Medicare wellness visit with a follow up visit?

Combining a wellness visit with a follow-up office visit will save you time by eliminating an extra appointment, but doing so may affect your costs. Additional concerns beyond a wellness visit may be billed to your insurance, which can  result in unplanned out-of-pocket costs to you. For these reasons, Weill Cornell Primary Care recommends that you schedule your annual wellness visit and any follow-up or sick office visits separately.

What are the most important points I need to keep in mind?

• Review your insurance plan’s summary of benefits before your appointment to understand what your insurance company will or will not cover.
• When scheduling a wellness visit, clearly state that you would like to make an appointment for your annual wellness or preventive care exam. That will help the practice prepare for your visit and bill your insurance company appropriately.
• When you speak with your doctor or other practitioner, let them know you are there for a wellness exam. Or, if you need to discuss a specific concern that may require treatment, make sure to bring their attention to any non-routine concerns at the start of your appointment.

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Common questions about Medicare annual wellness visits

If you are a Medicare recipient, you can take advantage of annual wellness visits. These visits are a preventive health benefit available after having Medicare Part B coverage for at least one year. All Medicare Advantage Plans are required to offer annual wellness visits for their members. A nurse or nurse practitioner reviews your health status and helps you plan for health and wellness needs.

In most cases, the annual wellness visit will be followed by a separate medical visit  with your primary care professional to close any health care gaps and address any problems identified during the visit.

Here are answers to common questions about annual wellness visits.

Why are annual wellness visits important.

The annual wellness visit allows you to review your health history and identify any current or potential health risks with a health care professional. The visit enables the nurse to focus on prevention and wellness while making sure you are current on recommended immunizations and health screenings like colonoscopies or mammograms. It also allows your primary care professional more time to focus on your medical concerns and needs at a separate physical exam.

Do I need to be 65 or older to have an annual wellness visit?

You do not need to be 65 or older to qualify for an annual wellness visit as long as you've been on Medicare Part B for at least one year.

How is an annual wellness visit scheduled?

If you are due for an annual wellness visit, you may be prompted to self-schedule the visit in the patient portal . You also may call your care team and ask to be scheduled.

If your visit is with a nurse or nurse practitioner, it's recommended to schedule this visit before the visit with your primary care professional. This allows your primary care professional the chance to address any concerns mentioned during your annual wellness visit.

How can I prepare for my annual wellness visit?

You may be asked to complete some questionnaires before arriving for your appointment, which will be sent to your patient portal account. If you cannot access the questionnaires before the appointment, plan to arrive at your appointment early to complete them.

It's helpful to come prepared to your visit with this information:

• All medications, vitamins and supplements you take, including how much and how often you take them
• Additional medical records, including immunization records
• Dates of your most recent preventive services, like a colonoscopy or mammogram, if completed by another health care facility
• Family health history, with as much detail as possible
• List of medical providers and suppliers who provide you care, equipment or services

What can you expect during an annual wellness visit?

During the visit, you'll meet with a nurse or nurse practitioner to:.

• Evaluate your fall risk
• Measure your height, weight and blood pressure
• Offer referrals to other health education or preventive services
• Provide information related to voluntary advance care planning
• Screen for cognitive impairments like dementia
• Screen for depression
• Update your medical and family history

What is the cost of an annual wellness visit?

Medicare offers the visit at no cost for people who have Medicare Part B coverage for at least one year before the visit. If you are referred for other tests or services, they will be billed to your insurance. If you have a separate visit with your primary care professional following your annual wellness visit, you or your insurance carrier will be responsible for the cost of that visit.

Robert Stroebel, M.D. , is a Community Internal Medicine, Geriatric and Palliative Care physician at Mayo Clinic Primary Care in Rochester and Kasson, Minnesota.

Related Posts

Yearly "Wellness" visits

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

Your costs in Original Medicare

You pay nothing for this visit if your doctor or other health care provider accepts assignment .

The Part B deductible  doesn’t apply. 

However, you may have to pay coinsurance , and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Your health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop or udate a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

• Routine measurements (like height, weight, and blood pressure).
• A review of your medical and family history.
• A review of your current prescriptions.
• Personalized health advice.
• Advance care planning .
• A screening schedule (like a checklist) for appropriate preventive services.
• An optional “ Social Determinants of Health Risk Assessment ” to help your provider understand your social needs and their impact on your treatment.  

Your health care provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your health care provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.

If you have a current prescription for opioids, your doctor or other health care provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your doctor or other health care provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use , and refer you for treatment, if needed. 

Related resources

• Preventive visits
• Social determinants of health risk assessment

Is my test, item, or service covered?

6 Important Blood Tests

Which blood tests do you really need? And how often should you get them done?

By Laura Entis

Sometimes it may feel like almost every visit to the doctor includes a dreaded blood draw. Blood tests can reveal a lot about the state of your health. But whether you should get a specific test (and how often) depends on your health and medical history; more is not always better.

Here’s what to know about three blood tests everyone should get and three others you may want to consider.

Complete Blood Count

A complete blood count (CBC) measures red and white blood cells as well as platelets. It can help identify infections, conditions like anemia, and even blood cancer.

How often should you get one? It depends. If you’re in good health, "every two to three years is fine," says says Stephen Kopecky, MD, a cardiologist at the Mayo Clinic in Rochester, Minn.

But if you have a condition that needs to be monitored more closely or if you’re on certain medications, including some prescription drugs for high blood pressure or cholesterol, "it should be done annually."

Metabolic Panel

A basic metabolic panel is used to assess glucose levels and can screen for diabetes and prediabetes. The test "also looks at kidney and liver function, thyroid function, and electrolytes such as potassium, sodium, and calcium," says Kopecky.

A comprehensive panel includes all of the above plus six different tests of liver function. Both typically require fasting.

How often should you get one? The U.S. Preventive Services Task Force recommends every three years for adults who are obese or overweight but have normal glucose levels. Some other experts recommend that schedule for everyone 45 and older.

Lipid Panel

A lipid panel, which may require fasting beforehand, measures cholesterol and triglyceride levels. High or borderline high results can indicate an increased risk of heart disease.

How often should you get one? Every year for those over 65, according to the National Institutes of Health .

An A1C test measures your average blood sugar levels over the past three months and can be a useful tool for diagnosing diabetes and prediabetes. It doesn’t require fasting, Kopecky says. But it’s often not covered by Medicare, says Matthew Weissman, MD, site chair of the department of medicine at Mount Sinai Beth Israel Hospital and Mount Sinai Downtown.

Who should get one? The Centers for Disease Control and Prevention recommends everyone over 45 get at least a baseline A1C. If your result is normal but you have risk factors such as being overweight, the agency advises repeating the test every three years.

A TSH (thyroid-stimulating hormone) test can flag dysfunction of the thyroid gland, either overactivity (hyperthyroidism) or underactivity (hypothyroidism), says C. Noel Bairey Merz, MD, director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles. While treatable and rarely life-threatening, a thyroid imbalance "affects pretty much every organ system," Bairey Merz says, which can lead to a wide range of symptoms, including weight changes and sleep problems.

Who should get one? If you have a family history of thyroid disease, Weissman recommends getting tested every few years. If you don’t and you’re asymptomatic, the evidence on regular screening is insufficient . "For many aging adults, it is a reasonable screening test," Bairey Merz says.

Testing for vitamin D is somewhat controversial. Proponents, including Kopecky, say it can be useful for flagging a common deficiency. Critics, Bairey Merz included, point to randomized trials that have raised questions about the health benefits of taking vitamin D supplements.

Who should get one? In Weissman’s practice, he generally recommends the test only for those with osteoporosis to ensure vitamin D deficiency isn’t a potential cause. "There has been mixed data around what diseases supplementing vitamin D can actually help," he says.

Editor’s Note:  This article also appeared in the February 2024 issue of  Consumer Reports On Health .

Correction: This article, published Feb. 6, 2024, originally conflated elements of the complete blood count and the metabolic panel. It has been corrected.

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Copyright © 2024, Consumer Reports, Inc.

KATHERINE TURNER, MD

Am Fam Physician. 2018;98(6):347-353

Related letter: Well-Child Visits Provide Physicians Opportunity to Deliver Interconception Care to Mothers

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

Clinical Examination

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions. 1 Evaluate breastfed infants for any feeding problems, 2 and assess formula-fed infants for type and quantity of iron-fortified formula being given. 3 For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all newborn screening tests ( Table 1 4 – 7 ) and schedule follow-up visits as necessary. 2

PHYSICAL EXAMINATION

A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts can be found at https://www.cdc.gov/growthcharts/who_charts.htm#The%20WHO%20Growth%20Charts . Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. 8

The USPSTF and AAP screening recommendations are outlined in Table 2 . 3 , 9 – 27 A summary of AAP recommendations can be found at https://www.aap.org/en-us/Documents/periodicity_schedule.pdf . The American Academy of Family Physicians (AAFP) generally adheres to USPSTF recommendations. 28

MATERNAL DEPRESSION

Prevalence of postpartum depression is around 12%, 22 and its presence can impair infant development. The USPSTF and AAP recommend using the Edinburgh Postnatal Depression Scale (available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1 ) or the Patient Health Questionnaire-2 (available at https://www.aafp.org/afp/2012/0115/p139.html#afp20120115p139-t3 ) to screen for maternal depression. The USPSTF does not specify a screening schedule; however, based on expert opinion, the AAP recommends screening mothers at the one-, two-, four-, and six-month well-child visits, with further evaluation for positive results. 23 There are no recommendations to screen other caregivers if the mother is not present at the well-child visit.

PSYCHOSOCIAL

With nearly one-half of children in the United States living at or near the poverty level, assessing home safety, food security, and access to safe drinking water can improve awareness of psychosocial problems, with referrals to appropriate agencies for those with positive results. 29 The prevalence of mental health disorders (i.e., primarily anxiety, depression, behavioral disorders, attention-deficit/hyperactivity disorder) in preschool-aged children is around 6%. 30 Risk factors for these disorders include having a lower socioeconomic status, being a member of an ethnic minority, and having a non–English-speaking parent or primary caregiver. 25 The USPSTF found insufficient evidence regarding screening for depression in children up to 11 years of age. 24 Based on expert opinion, the AAP recommends that physicians consider screening, although screening in young children has not been validated or standardized. 25

DEVELOPMENT AND SURVEILLANCE

Based on expert opinion, the AAP recommends early identification of developmental delays 14 and autism 10 ; however, the USPSTF found insufficient evidence to recommend formal developmental screening 13 or autism-specific screening 9 if the parents/caregivers or physician have no concerns. If physicians choose to screen, developmental surveillance of language, communication, gross and fine movements, social/emotional development, and cognitive/problem-solving skills should occur at each visit by eliciting parental or caregiver concerns, obtaining interval developmental history, and observing the child. Any area of concern should be evaluated with a formal developmental screening tool, such as Ages and Stages Questionnaire, Parents' Evaluation of Developmental Status, Parents' Evaluation of Developmental Status-Developmental Milestones, or Survey of Well-Being of Young Children. These tools can be found at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx . If results are abnormal, consider intervention or referral to early intervention services. The AAP recommends completing the previously mentioned formal screening tools at nine-, 18-, and 30-month well-child visits. 14

The AAP also recommends autism-specific screening at 18 and 24 months. 10 The USPSTF recommends using the two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening tool (available at https://m-chat.org/ ) if a physician chooses to screen a patient for autism. 10 The M-CHAT can be incorporated into the electronic medical record, with the possibility of the parent or caregiver completing the questionnaire through the patient portal before the office visit.

IRON DEFICIENCY

Multiple reports have associated iron deficiency with impaired neurodevelopment. Therefore, it is essential to ensure adequate iron intake. Based on expert opinion, the AAP recommends supplements for preterm infants beginning at one month of age and exclusively breastfed term infants at six months of age. 3 The USPSTF found insufficient evidence to recommend screening for iron deficiency in infants. 19 Based on expert opinion, the AAP recommends measuring a child's hemoglobin level at 12 months of age. 3

Lead poisoning and elevated lead blood levels are prevalent in young children. The AAP and CDC recommend a targeted screening approach. The AAP recommends screening for serum lead levels between six months and six years in high-risk children; high-risk children are identified by location-specific risk recommendations, enrollment in Medicaid, being foreign born, or personal screening. 21 The USPSTF does not recommend screening for lead poisoning in children at average risk who are asymptomatic. 20

The USPSTF recommends at least one vision screening to detect amblyopia between three and five years of age. Testing options include visual acuity, ocular alignment test, stereoacuity test, photoscreening, and autorefractors. The USPSTF found insufficient evidence to recommend screening before three years of age. 26 The AAP, American Academy of Ophthalmology, and the American Academy of Pediatric Ophthalmology and Strabismus recommend the use of an instrument-based screening (photoscreening or autorefractors) between 12 months and three years of age and annual visual acuity screening beginning at four years of age. 31

IMMUNIZATIONS

The AAFP recommends that all children be immunized. 32 Recommended vaccination schedules, endorsed by the AAP, the AAFP, and the Advisory Committee on Immunization Practices, are found at https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season. Additional vaccinations may be necessary based on medical history. 33 Immunization history should be reviewed at each wellness visit.

Anticipatory Guidance

Injuries remain the leading cause of death among children, 34 and the AAP has made several recommendations to decrease the risk of injuries. 35 – 42 Appropriate use of child restraints minimizes morbidity and mortality associated with motor vehicle collisions. Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). 35 Children should never be unsupervised around cars, driveways, and streets. Young children should wear bicycle helmets while riding tricycles or bicycles. 37

Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. 36 Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. 37 Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. 38

Infants should not be left alone on any high surface, and stairs should be secured by gates. 43 Infant walkers should be discouraged because they provide no benefit and they increase falls down stairs, even if stair gates are installed. 39 Window locks, screens, or limited-opening windows decrease injury and death from falling. 40 Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept unloaded and locked. 41

Young children should be closely supervised at all times. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. 42 Long strings and cords can strangle children. 37

DENTAL CARE

Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. 44 Juices should be avoided in infants younger than 12 months. 45 Fluoride use inhibits tooth demineralization and bacterial enzymes and also enhances remineralization. 11 The AAP and USPSTF recommend fluoride supplementation and the application of fluoride varnish for teeth if the water supply is insufficient. 11 , 12 Begin brushing teeth at tooth eruption with parents or caregivers supervising brushing until mastery. Children should visit a dentist regularly, and an assessment of dental health should occur at well-child visits. 44

SCREEN TIME

Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increases the risk of obesity and social-emotional delays. 46

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. 45 Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS. 47

DIET AND ACTIVITY

The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. 48 Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. 49 Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods 50 and an increased risk of atopic disease. 51 Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. 52 Introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year decreases the likelihood that a child will develop food allergies. 53

With approximately 17% of children being obese, many strategies for obesity prevention have been proposed. 54 The USPSTF does not have a recommendation for screening or interventions to prevent obesity in children younger than six years. 54 The AAP has made several recommendations based on expert opinion to prevent obesity. Cessation of breastfeeding before six months and introduction of solid foods before six months are associated with childhood obesity and are not recommended. 55 Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities: 4 ounces per day from one to three years of age and 4 to 6 ounces per day from four to six years of age. Intake of other sugar-sweetened beverages should be discouraged to help prevent obesity. 45 The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. 55 , 56

Data Sources: Literature search was performed using the USPSTF published recommendations ( https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations ) and the AAP Periodicity table ( https://www.aap.org/en-us/Documents/periodicity_schedule.pdf ). PubMed searches were completed using the key terms pediatric, obesity prevention, and allergy prevention with search limits of infant less than 23 months or pediatric less than 18 years. The searches included systematic reviews, randomized controlled trials, clinical trials, and position statements. Essential Evidence Plus was also reviewed. Search dates: May through October 2017.

Gauer RL, Burket J, Horowitz E. Common questions about outpatient care of premature infants. Am Fam Physician. 2014;90(4):244-251.

American Academy of Pediatrics; Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics. 2010;125(2):405-409.

Baker RD, Greer FR Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040-1050.

Mahle WT, Martin GR, Beekman RH, Morrow WR Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics. 2012;129(1):190-192.

American Academy of Pediatrics Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192-217.

American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-1198.

Christian CW Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse [published correction appears in Pediatrics . 2015;136(3):583]. Pediatrics. 2015;135(5):e1337-e1354.

Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for autism spectrum disorder in young children: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(7):691-696.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Moyer VA. Prevention of dental caries in children from birth through age 5 years: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2014;133(6):1102-1111.

Clark MB, Slayton RL American Academy of Pediatrics Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633.

Siu AL. Screening for speech and language delay and disorders in children aged 5 years and younger: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2015;136(2):e474-e481.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics . 2006;118(4):1808–1809]. Pediatrics. 2006;118(1):405-420.

Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.

National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. October 2012. https://www.nhlbi.nih.gov/sites/default/files/media/docs/peds_guidelines_full.pdf . Accessed May 9, 2018.

Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents [published correction appears in Pediatrics . 2017;140(6):e20173035]. Pediatrics. 2017;140(3):e20171904.

Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics. 2015;136(4):746-752.

U.S. Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women. Pediatrics. 2006;118(6):2514-2518.

Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials . Atlanta, Ga.: U.S. Public Health Service; Centers for Disease Control and Prevention; National Center for Environmental Health; 1997.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and post-partum women: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;315(4):388-406.

Earls MF Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039.

Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366.

Weitzman C, Wegner L American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics; Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems [published correction appears in Pediatrics . 2015;135(5):946]. Pediatrics. 2015;135(2):384-395.

Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children aged 6 months to 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;318(9):836-844.

Donahue SP, Nixon CN Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Academy of Pediatrics; American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

Lin KW. What to do at well-child visits: the AAFP's perspective. Am Fam Physician. 2015;91(6):362-364.

American Academy of Pediatrics Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.

Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38(3):315-328.

American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment of infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

American Academy of Family Physicians. Clinical preventive service recommendation. Immunizations. http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html . Accessed October 5, 2017.

Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Accessed May 9, 2018.

National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States—2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif . Accessed April 24, 2017.

Durbin DR American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788-793.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355-1357.

Gardner HG American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics. 2007;119(1):202-206.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of drowning in infants, children, and adolescents. Pediatrics. 2003;112(2):437-439.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Injuries associated with infant walkers. Pediatrics. 2001;108(3):790-792.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107(5):1188-1191.

Dowd MD, Sege RD Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of choking among children. Pediatrics. 2010;125(3):601-607.

Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention (review). Evid Based Child Health. 2013;8(3):761-939.

American Academy of Pediatrics Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-1229.

Heyman MB, Abrams SA American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.

Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591.

Moon RY Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940.

American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.

Wagner CL, Greer FR American Academy of Pediatrics Section on Breastfeeding; Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents [published correction appears in Pediatrics . 2009;123(1):197]. Pediatrics. 2008;122(5):1142-1152.

Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544-e551.

Greer FR, Sicherer SH, Burks AW American Academy of Pediatrics Committee on Nutrition; Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.

American Academy of Pediatrics Committee on Nutrition. The use of whole cow's milk in infancy. Pediatrics. 1992;89(6 pt 1):1105-1109.

Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013;1(1):29-36.

Grossman DC, Bibbins-Domingo K, Curry SJ, et al. Screening for obesity in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426.

Daniels SR, Hassink SG Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292.

American Academy of Family Physicians. Physical activity in children. https://www.aafp.org/about/policies/all/physical-activity.html . Accessed January 1, 2018.

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