Medicare Annual Wellness Visit Page 6
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6Name_____________________________________________________
Date______________
Based upon your responses to the questionnaire and our discussion today, the
following recommendations have been made for you if circled:
Increase weight bearing exercise
Calcium 600mg and Vitamin D 400 IU combination pill twice daily
Aspirin 81 mg daily
Annual eye exam
Regular dental visits
Driver evaluation
Further memory testing
Advance care planning
Contact your gastroenterologist to determine when next colonoscopy is due
Physical Therapy
Zostavax (shingles vaccine)
Return to our office to further discuss _________________________________
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