Form preview

Get the free Well Child Check-Up (EPSDT)

Get Form
The EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) program aims to ensure that eligible children and youth receive preventive health care services to detect any physical or mental
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign well child check-up epsdt

Edit
Edit your well child check-up epsdt form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your well child check-up epsdt form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing well child check-up epsdt online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Follow the steps below to benefit from a competent PDF editor:
1
Log into your account. It's time to start your free trial.
2
Upload a document. Select Add New on your Dashboard and transfer a file into the system in one of the following ways: by uploading it from your device or importing from the cloud, web, or internal mail. Then, click Start editing.
3
Edit well child check-up epsdt. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.
4
Save your file. Select it from your records list. Then, click the right toolbar and select one of the various exporting options: save in numerous formats, download as PDF, email, or cloud.
It's easier to work with documents with pdfFiller than you could have ever thought. You can sign up for an account to see for yourself.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out well child check-up epsdt

Illustration

How to fill out Well Child Check-Up (EPSDT)

01
Gather necessary information about the child, including their personal details and medical history.
02
Complete the identification section on the form with the child's name, date of birth, and insurance information.
03
Provide details of the child's health history, including any allergies, medications, and previous illnesses.
04
Answer questions regarding the child's development and behavior, including milestones reached.
05
Fill out any required sections for immunizations, ensuring to include dates of administered vaccines.
06
Schedule the appointment for the check-up, ensuring to select a pediatrician who is a qualified EPSDT provider.
07
Bring the completed form and any additional documents to the appointment for the healthcare provider.

Who needs Well Child Check-Up (EPSDT)?

01
All children under the age of 21 are eligible for Well Child Check-Ups (EPSDT).
02
Children who are enrolled in Medicaid or state health insurance programs need Well Child Check-Ups.
03
Children with specific health concerns or developmental issues may also require these check-ups.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
30 Votes

People Also Ask about

At this exam, the health care provider will check the child's growth and development in order to find or prevent problems. The provider will record your child's height, weight, and other important information. Hearing, vision, and other screening tests will be part of some visits.
Most health plans must cover a set of preventive health services for children at no cost. This includes Marketplace and Medicaid coverage. These services are free only when delivered by a doctor or other provider in your plan's network.
At this exam, the health care provider will check the child's growth and development in order to find or prevent problems. The provider will record your child's height, weight, and other important information. Hearing, vision, and other screening tests will be part of some visits. So will immunizations.
EPSDT Requirements: A Summary Comprehensive health and developmental history -- includes assessment of physical and mental health development. Comprehensive unclothed physical exam. Appropriate immunizations -- ing to the Advisory Committee on Immunization Practices (ACIP) schedule for pediatric vaccines.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Well Child Check-Up (EPSDT) is a Medicaid program for children that provides comprehensive and preventative health care services to ensure their physical, mental, and emotional well-being.
Providers who give medical services to Medicaid-eligible children are required to file for Well Child Check-Up (EPSDT) to ensure necessary screenings and check-ups are conducted.
To fill out Well Child Check-Up (EPSDT), providers should complete the necessary forms by documenting the child's health information, including screenings, assessments, immunizations, and any recommendations for further care.
The purpose of Well Child Check-Up (EPSDT) is to promote health, identify health problems early, and ensure that children receive necessary medical, dental, and mental health services.
Information that must be reported includes the child's height, weight, immunization status, screenings for vision and hearing, developmental assessments, and any findings or referrals made during the check-up.
Fill out your well child check-up epsdt online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.