Medicare Annual Wellness Visit (Page 4 of 4) in pdf

Medicare Annual Wellness Visit Page 4

Lalita Matta, MD | Estrela Chaves, NP, CDE

65 FREMONT STREET | MARLBOROUGH, MA 01752

P: 508-303-8553 | F: 508-303-0665

Talk with your doctor or other health care provider about which of these services are right for you. As part of your

yearly "Wellness" visit, you may be asked to fill out a Health Risk Assessment to help you figure out what to work on

to stay healthy. To learn more, visit

Medicare-Covered Preventative Service

I need

Date Last

Next Date Medicare

(Yes/No)

Received

Covers This Service

"Welcome to Medicare": Preventative Visit (one-time) within first 12

months you have Medicare Part B

Yearly "Wellness" Visit -12 months after "Welcome to Medicare" visit

or Part B effective date

Abdominal Aortic Aneurysm Screening

Bone Mass Measurement (Bone Density Test)

Breast Cancer Screening (mammogram)

Cardiovascular Screenings (cholesterol, lipids, triglycerides)

Cervical and Vaginal Screening

Colorectal Cancer Screening

Fecal Occult Blood Test

Flexible Sigmoidoscopy

Colonoscopy

Barium Enema

Diabetes Screening

Diabetes Self Management Training

Flu Shot

Glaucoma Test

Hepatitis B Shot

HIV Screening

Medication Nutrition Therapy Services

Pneumococcal Shot

Prostate Cancer Screening

Tobacco Use Cessation Counseling

(counseling for people with no sign of tobacco-related disease)

For some services, you will need to wait a certain amount of time before getting the service again. See pages

37 - 53 of the Medicare & You 2012 handbook for more information. This sheet is on Page 3, just inside front cover.

Rev. 01/26/2015

Medicare Annual Wellness Visit Page 4