Medicare Annual Wellness Visit (Page 3 of 3) in pdf

Medicare Annual Wellness Visit Page 3

Patient’s Name _________________________________________________

Medicare Preventative Services Recommendations for You

Mammogram every 1- 2 years for women until age 85

Glaucoma screening with your optometrist or ophthalmologist every 2 years

Vision screening as recommended by your eye care provider

Diabetes screening every year

Cholesterol screening at least every 5 years

Colonoscopy screening every 10 years until age 75 or more frequently as recommended

Influenza vaccine yearly

Shingles vaccine once after age 60 (This may or may not be covered by Medicare part D depending upon

insurance coverage purchased by patient)

Pneumonia vaccine (Pneumoccal-23) once after age 65 (This is covered by Medicare)

Other Pneumonia vaccine (Prevnar-13) once after age 65 (This is covered by Medicare)

Tetanus /pertussis/diphtheria booster once after age 65 and every 10 years (This is NOT paid for by Medicare

and is an additional cost to the patient)

DEXA scan screening for osteoporosis in women after age 65 and in high risk men after age 70

Stop smoking

Decrease alcohol

Exercise for 30 minutes or more 3 times a week

Lose weight

Dietary Recommendations:

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Make one half your plate fruits and vegetables

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Make at least half your grains whole

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Choose foods and drinks with little or no added sugars

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Look out for salt (sodium) in foods you buy

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Eat fewer foods that are high in saturated fats (animal fat, butter, cream, whole milk, stick margarine,

coconut and palm oil

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Eat the right amount of calories for you (get your personal daily calorie limit at )

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Use food labels to help you make better food choices

Medicare Annual Wellness Visit Page 3