Get the free EPSDT Tracking Forms - Mercy Care Plan

APPENDIX B EPS DT STANDARDS AND TRACKING FORMS AHC CCS EPS DT TRACKING FORMS The Arizona Health Care Cost Containment System (AHC CCS) EPS DT Tracking Forms must be used by all providers offering

How to fill out epsdt tracking forms

How to fill out EPSDT tracking forms:

1. Start by gathering all necessary information such as the child's personal details, including their full name, date of birth, and contact information.
2. Fill out the demographic information section, which may include the child's gender, race/ethnicity, and primary language spoken.
3. Provide the child's medical history, including any existing conditions or concerns. Include information about previous screenings, diagnoses, and treatments.
4. Record the child's growth and developmental milestones. This may involve noting the child's height, weight, head circumference, and other relevant measurements.
5. Include information about any developmental screenings or assessments that have been conducted.
6. Document any recommended or completed immunizations. Make sure to include the specific vaccines received and the dates they were administered.
7. Note any vision or hearing screenings performed and the results obtained.
8. Record any oral health screenings or assessments that have been completed.
9. Detail any further referral or follow-up recommendations based on the child's screenings or assessments.
10. Review the completed form for accuracy and completeness before submitting it.

Who needs EPSDT tracking forms:

1. Parents or legal guardians of children who qualify for Medicaid or CHIP (Children's Health Insurance Program) typically need to fill out EPSDT tracking forms.
2. Healthcare providers who offer EPSDT services also need to maintain these forms to track and monitor the child's overall health and development.
3. State and federal agencies responsible for overseeing Medicaid and CHIP programs require these tracking forms for record keeping and program evaluation purposes.

For pdfFiller’s FAQs

What is epsdt tracking forms?

EPSDT tracking forms are used to monitor and track the provision of Early and Periodic Screening, Diagnostic, and Treatment services for Medicaid-eligible individuals under the age of 21.

Who is required to file epsdt tracking forms?

Healthcare providers who serve Medicaid-eligible individuals under the age of 21 are required to file EPSDT tracking forms.

How to fill out epsdt tracking forms?

EPSDT tracking forms can be filled out by documenting the screenings, diagnostics, and treatments provided to Medicaid-eligible individuals under the age of 21.

What is the purpose of epsdt tracking forms?

The purpose of EPSDT tracking forms is to ensure that Medicaid-eligible individuals under the age of 21 receive the necessary screenings, diagnostics, and treatments to address their health needs.

What information must be reported on epsdt tracking forms?

EPSDT tracking forms must report the dates of screenings, diagnostics, and treatments provided to Medicaid-eligible individuals under the age of 21.

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