Pre-visit Checklist

>> Pre-visit Checklist

What do you need to do before each visit? Whether it's your first time, a wellness visit or a repeat visit for an acute condition such as Asthma, this chart helps you know what vaccines are needed and what forms should be completed.

The most important step before your visit is to go online to our secure website "Chadis". You will find prescreening forms here that you can complete in the comfort of your home. The more you do online prior to your visit, the easier it will be for both you a

Check-Up	Vaccine	Complete in Portal or Pre-Visit Screen
First Visit/ Newborn Visit	Hep B	HIPAA Privacy Practice HIPAA Form Patient Profile Authorization to use/release records (excluding Newborns) Chadis /Inv Code 9197865001
2 Week	Hep B (If not given at Hospital)	Chadis /Inv Code 9197865001
1 Month	Hep B	Chadis /Inv Code 9197865001
2 Months	Dtap, IPV, HIB, Prevnar, Rotavirus	Chadis /Inv Code 9197865001
4 Months	Dtap, IPV, HIB, Prevnar, Rotavirus	Chadis /Inv Code 9197865001
6 Months	Dtap, IPV, HIB, Prevnar, Rotavirus	Chadis /Inv Code 9197865001
9 Months	Hep B	Daycare Form Chadis /Inv Code 9197865001
12 Months	Prevnar, HIB, MMR, Varicella	Patient Profile JMA Patient Responsibilities Daycare Form Chadis /Inv Code 9197865001
15 Months	Dtap, Hep A	Daycare Form Chadis /Inv Code 9197865001
18 Months		Daycare Form Chadis /Inv Code 9197865001
2 Year	Hep A	Patient Profile JMA Patient Responsibilities Daycare Form Chadis /Inv Code 9197865001
3 Year		Patient Profile JMA Patient Responsibilities Daycare Form Chadis /Inv Code 9197865001
4 Year*	Dtap, IPV, MMR, Varicella	Patient Profile JMA Patient Responsibilities Kindergarten Form Chadis /Inv Code 9197865001
5 Year*	Dtap, IPV, MMR, Varicella (if not given at 4 Yr checkup)	Patient Profile JMA Patient Responsibilities Kindergarten Form Chadis /Inv Code 9197865001
6-10 Years*		Patient Profile JMA Patient Responsibilities Physical Form Chadis /Inv Code 9197865001
11-12 Years*	Tdap, Menactra, Gardasil (females) may need catch up on Varicella #2 and Hep A series	Patient Profile JMA Patient Responsibilities Physical Form Chadis /Inv Code 9197865001
13-21 Years*		Patient Profile JMA Patient Responsibilities Physical Form Chadis /Inv Code 9197865001
Asthma		4-11 Asthma Form - ACT Form 12 & Up Asthma Form - ACT Form Chadis /Inv Code 9197865001
ADD/ADHD New Patient		Parent Letter List of Psychologists Vanderbilt Teacher Informant Vanderbilt Parent Informant Chadis /Inv Code 9197865001
ADD/ADHD Established Patient		Vanderbilt Teacher Follow-Up Vanderbilt Parent Follow-Up Chadis /Inv Code 9198765001

*Vision, Hearing, and BP tests are given at well check-up visits for ages 4-21. Vision and BP tests are given at age 3 well check-up visits.

Pre-visit Checklist

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