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Get the free Medicare Annual Wellness Visit Questionnaire

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This questionnaire is designed to assess various aspects of your health, including tobacco and alcohol use, drug screening, hearing, functionality, home safety, nutrition, advanced care planning, fall risk assessment, and exercise habits, to enhance your healthcare management during the Medicare Annual Wellness Visit.
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How to fill out medicare annual wellness visit

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How to fill out medicare annual wellness visit

01
Gather your medical history, including any recent tests or evaluations.
02
Make a list of any medications you currently take including dosages.
03
Prepare a list of questions or concerns you want to discuss with your healthcare provider.
04
Schedule the appointment with your healthcare provider.
05
Fill out any required forms upon arrival, providing your insurance information and personal details.
06
During the visit, allow your provider to assess your overall health, including measurements like height, weight, blood pressure, and BMI.
07
Participate in discussions about preventive services, screenings, and vaccinations you may need.
08
Update your healthcare provider on any changes in your health or new symptoms.

Who needs medicare annual wellness visit?

01
Medicare beneficiaries who are at least 65 years old.
02
Individuals who have been enrolled in Medicare Part B for more than 12 months.
03
People who have not received a wellness visit in the past 12 months.
04
Anyone seeking preventative care to maintain or improve their health.
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The Medicare Annual Wellness Visit is a yearly appointment that allows Medicare beneficiaries to develop or update a personalized prevention plan based on their health and risk factors. It focuses on preventive care and health maintenance.
Any Medicare beneficiary who has been enrolled in Medicare Part B for longer than 12 months is eligible to receive an annual wellness visit. It is not mandatory for them to file for one, but it is recommended to ensure preventive care.
To fill out the Medicare Annual Wellness Visit, the healthcare provider will utilize specific forms to gather patient information, including a medical history, medication list, and a checklist of health screenings and preventive services. Beneficiaries may also need to provide basic health information before the visit.
The purpose of the Medicare Annual Wellness Visit is to identify current health concerns and risk factors, promote preventive health measures, and create or update a personalized prevention plan to enhance overall health and well-being.
During the Medicare Annual Wellness Visit, information such as the patient's medical history, medications, family health history, health risk assessment, and a personalized prevention plan must be reported. Additional information regarding screenings and preventive services may also be included.
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