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Recommended Services for age: 20 years

History, Physical & Developmental and Assessment
Condition Specific Risk Assessment & Screening
Routine Preventive Interventions

Note: Annual adolscent visits: Emphasize developmental, psychosocial, behavioral and risk assessment.

Key
Symbol	Indicates
	Service is Routine for all
	Service is Not Routine—Provide when indicated by risk assessment

History, Physical & Developmental and Assessment

Service	Components/Tools
A Comprehensive History	Do Comprehensive History
Blood Pressure	Determine percentile for age and size Blood Pressure: NHLBI-NIH Report on Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents
Height & Weight	Measure the adolescent's height and weight, and calculate body mass index (BMI). Plot these on the CDC growth charts and share information with the adolescent and family. Type 2 Diabetes and Pre-Diabetes: Assessing Risk Growth Charts Article Growth Chart (CDC): 2 to 20 Years: Boys, Body mass index-for-age percentiles Growth Chart (CDC): 2 to 20 Years: Girls, Body mass index-for-age percentiles
Comprehensive Physical Assessment	As part of a complete physical examination, the following should be particularly noted: Acne and common dermatoses Cultural Competency: Self teaching module for the influence of culture and pigment on skin conditions in children Caries, developmental dental anomalies, malocclusion, gingivitis, pathologic conditions, or dental injuries Evaluate for Sexual Maturity Rating or Tanner Stage Tanner Stages Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network Evidence of eating disorders (e.g., extreme weight loss or gain, erosion of tooth enamel) Evidence of possible neglect or abuse Excessive Body Hair (Hirsutism) For Females: An external genital exam should be performed. Examine genitals for normal development. Check for condyloma/lesions, vulvovaginitis. If adolescent is sexually active or has primary amenorrhea or menstrual complaints, perform pelvic exam and evaluate. Teach breast self-examination and encourage monthly breast self-exams at home. Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network Tanner Stages For Females: Offer pelvic examination and Pap smear (begin under 18 years if patient is sexually active) For Males: An external genital exam should be performed. Teach testicular self-examination. Examine genitals for normal development. Check for varicoceles, hernias, condyloma/lesions, testicular cancer. (Risk criteria for testicular cancer include history of undescended testes, single testicle.) Evaluate for gynomastia. Tanner Stages Sports inujuries, other orthopedic problems Tatoos, piercing
Developmental Assessment	Systematic developmental assessment by history and observation Sexual Orientation and Adolescents (AAP Clinical Report) Cultural Competency: Developmental and Physical Assessment Developmental Screening for Health Care Providers
Emotional and Behavioral Assessment	Perform psychosocial and behavioral assessment Assets for Adolescents Emotional and Behavioral Health-Assessment Tools Mental Health Services By County Refugee Mental Health Assessment

Condition Specific Risk Assessment & Screening

Service	Components/Tools
Cholesterol Screening	Assess Risk Cholesterol in Childhood (AAP Policy Statement) Serum Cholesterol and/or Lipid Profile -- as indicated
Hearing Screening	Assess Risk Hearing Impairment: Assessing Risk Objective Test (may obtain results from school screening if assured that appropriate technique was properly employed)
Hematocrit or Hemoglobin	Assess risk for iron deficiency anemia Iron Deficiency Anemia: Assessing Risk One routine HCT or HGB for menstruating females, for others, test if indicated by risk assessment
Oral Health Screening	Assess Risk Dental Health: Assessing Risk Oral Health - Dental Periodicity Schedule Assess Compliance with Routine Dentist Visits Oral Health - Dental Periodicity Schedule Assess Fluoride Status Oral Health - Dental Periodicity Schedule
Tuberculosis Screening	Assess Risk Tuberculin Skin Testing: Assessing Risk Tuberculosis Flowsheet -- Evaluation for Active Pulmonary TB or Latent TB Infection Tuberculosis: Targetted TB Skin Testing and Treatment of Latent TB Infection in Children and Adolescents (AAP Article) Reportable Diseases--Vt. Dept. of Health Mantoux Test -- Results to be read by appropriately trained health care provider. Evaluate younger infants as medically indicated. Tuberculosis Skin Testing -- Placement and Interpretation Reportable Diseases--Vt. Dept. of Health
Urinalysis	Provide if indicated by risk assessment Urinalysis (Need for): Assessing Risk
Vision Screening	Assess risk; do visual physical assessment, including assessment of ocular alignment Eye Examination and Vision Screening in Infants, Children and Young Adults (AAP Statement)

Routine Preventive Interventions

Service	Components/Tools
Anticipatory Guidance, Including Injury Prevention Counseling and other Health Education	As indicated by developmental level and individual circumstances. Educating Patients and Parents in Primary Care (Brief Approaches to) Gay, Lesbian and Bisexual Youth Non-sexual Risk Behaviors Vermont Vital Statistics Youth Health Survey 2006 (Vermont YHS) Youth Risk Behavior Survey 2007 (Vermont YRBS) Nutrition and Physical Activity Dietary Recommendations for Children and Adolescents: A Guide for Practitioners (AAP Statement) MyPyramid.Gov - Steps To a Healthier You (USDA) Tobacco and Substance Abuse Smoking Cessation Guidelines (for Adolescents): Assessing Risk Smoking Cessation--Guide to Helping Smokers Quit Smoking: Secondhand Smoke (brochure) Substance Abuse Treatment Directory Substance Use Screening and Counseling Guidelines (for Adolescents)--CRAFFT Screening Tool Transportion Safety Car Seats: Transportation Safety Q & A Car Seats: Update for the Pediatrician on Child Passenger Safety
Immunizations	Follow current recommendations of the Advisory Committee on Immunization Practices (ACIP) Immunization Administration Medicaid Payment Guidelines Immunization Information for Providers--Vt. Dept of Health (Last Reviewed 7/09) Immunization Schedule (Vermont) Immunization Schedule Ages 7-18 (CDC/ACIP) Immunization Schedule/Catch-Up Ages 4 months-18 years (CDC/ACIP)
Sexually Transmitted Diseases	If risk assessment reveals sexual activity with additional risk factors, test for hepatitis B virus (HBV) human immunodeficiency virus (HIV) and/or syphilis, as indicated by individual circumstances. Reportable Diseases--Vt. Dept. of Health Sexually Transmitted Diseases in Adolescents: Assessing Risk If risk assessment reveals sexual activity, test for chlamydia and gonorrhea, and screen for human papilloma virus (HPV). Sexually Transmitted Diseases in Adolescents: Assessing Risk Reportable Diseases--Vt. Dept. of Health

Provider’s Toolkit