The Medicare Annual Wellness Visit: Patient Name Help To Enjoy Better Health For A Longer Period
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HYSICIANS
The Medicare Annual Wellness Visit:
Patient Name ______________________
Help to enjoy better health for a longer time
Date of Birth _______________________
At Orange Family Physicians, we believe that good health is a shared responsibility. That’s why we are
especially pleased to offer our Medicare patients the opportunity for an Annual Wellness Visit (AWV). This
service is offered here in our office and is fully covered by Medicare.
The AWV is not a yearly physical exam - it is a special visit focused on
helping you
maintain or improve your
overall health. We will assess your current risks and you will leave with a plan for working with your physician
to decrease the chances of avoidable health decline and injury. Our goal is to provide all of our Medicare
patients with an AWV every year, so they can maintain their independence and enjoy life for as long as
possible.
Before your visit
You will be asked to complete a Health Risk Assessment (HRA) so that you can bring it to your visit. The HRA is
a paper-and-pencil questionnaire that takes from 20 to 30 minutes to finish. It is based on scientifically
validated health screening tools and includes questions about daily activities, functions like hearing and
mobility, and habits like eating and sleeping. Your honest answers will help us to help you, and they will
remain confidential.
The day of your visit
Your visit will take approximately 45 minutes. Our specially trained
Annual Wellness Visit Checklist
wellness nurse will review your current medicines and allergies, your
1. Bring these to your visit:
HRA, and any other health information your physician thinks is
important. Your blood pressure, height and weight will be taken, your
Completed Health Risk
eyesight will be checked, and the nurse will conduct several more
Assessment with a list of all your
assessments. You will receive a Personalized Prevention Plan that the
healthcare providers and
nurse will review with you before you leave the office.
suppliers
All current medications in the
After your visit
original prescription, over-the-
Your doctor will review your Personalized Prevention Plan and may
counter drug and supplement
identify any other actions you should take. These may include
bottles/packs
scheduling a follow-up appointment to review details of the Plan or
Family member or caregiver, if
address new risks or conditions identified during the AWV. Depending
they usually participate in your
on your needs, the wellness nurse may follow up with you between
doctor visits
visits. We encourage you to share your Plan with family members or
caregivers so they can support your commitment to good health.
2. Check-in at the front desk and tell
them you are here for your Annual
Wellness Visit
AWV Nurse Name _____________________________
3. Congratulate yourself for starting
Appointment Date __________________Arrival Time _______________
a new healthy habit— the Annual
Wellness Visit
I understand what is expected of me as part of the Orange Family Physicians Annual Wellness Visit.
Patient/Caregiver: ______________________________ Reviewed By:_________________________ Date ___________
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