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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. Please review our Vaccine Policy.

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.

 

Check-Up Vaccine Complete in Portal or Pre-Visit Screen
First Visit/
Newborn Visit
Hep B

 

HIPAA-Notice of Privacy Practices

HIPAA-Written Acknowledgement Form

Patient Profile Form 

Authorization to use/release records (excluding Newborns)
Chadis

2 Week Hep B (If not given at Hospital) Chadis
1 Month Hep B Chadis
2 Months Dtap, IPV, HIB, Prevnar, Rotavirus Chadis
4 Months Dtap, IPV, HIB, Prevnar, Rotavirus Chadis
6 Months Dtap, IPV, HIB, Prevnar, Rotavirus Chadis
9 Months Hep B

Daycare Form                          Chadis

12 Months Prevnar, HIB, MMR, Varicella

Patient Profile Form 
JMA Patient Responsibilities
Daycare Form
Chadis

15 Months Dtap, Hep A

Daycare Form                          Chadis

18 Months   Daycare Form
Chadis
2 Year Hep A

Patient Profile Form 
JMA Patient Responsibilities
Daycare Form
Chadis

3 Year  

Patient Profile Form 

JMA Patient Responsibilities
Daycare Form
Chadis
4 Year* Dtap, IPV, MMR, Varicella

Patient Profile Form  

JMA Patient Responsibilities
Kindergarten Form
Chadis
5 Year* Dtap, IPV, MMR, Varicella (if not given at 4 Yr checkup)

Patient Profile Form 

JMA Patient Responsibilities
NC Health Assessment Form
Chadis
6-10 Years*  

Patient Profile Form 
JMA Patient Responsibilities
Physical Form                           Chadis

11-12 Years* Tdap, Menactra, Gardasil may need catch up on Varicella #2 and Hep A series

Patient Profile Form 
JMA Patient Responsibilities
Physical Form                           Chadis

13-21 Years*  

Patient Profile Form under 18  or Patient Profile Form 18+
JMA Patient Responsibilities
Physical Form                           Chadis

Asthma  

4-11 Asthma Form - ACT Form
12 & Up Asthma Form - ACT Form   Chadis

ADD/ADHD 
New Patient
  Parent Letter
List of Psychologists
Vanderbilt Teacher Informant
Vanderbilt Parent Informant
Chadis
ADD/ADHD 
Established Patient
  Vanderbilt Teacher Follow-Up
Vanderbilt Parent Follow-Up
Chadis

 

*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.