Follow the steps to fill out the form accurately.

1. Press the ‘Get Form’ button to access the form and open it in the designated editor.
2. Begin by entering the patient's personal information at the top of the form, including the patient's name, date of birth, Part B eligibility date, and the date of the exam.
3. Complete the medical and social history section. Document past personal illnesses, injuries, or operations along with the hospitalization status if applicable.
4. List any allergies, tobacco use, alcohol use, drug use, and current medications, including supplements and vitamins.
5. Enter the current list of the patient's providers and suppliers, specifying the name, specialty, and the reason for seeing each provider.
6. Input the patient's height, weight, BMI, blood pressure, and visual acuity readings in the appropriate fields.
7. Check the family history for any conditions that apply to the patient, providing any necessary notes.
8. Answer the screening questions regarding the diet, cognitive impairment, depression, hearing loss, daily living activities, home safety, and falls risk as indicated.
9. Review the advanced care planning section, ensuring consent is documented and any directive discussions are noted.
10. Fill out the preventive screenings section with the relevant information, including coverage and scheduled procedures.
11. Complete the exam form, providing subjective and objective findings along with an impression, diagnosis, and plan.
12. Ensure that you provide signatures where necessary, and double-check all entered information for accuracy.
13. Finally, save your changes, and choose to download, print, or share the completed form as required.

Complete your Wellness Visit documentation online today for a seamless experience.