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.

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