Screening and Preventive Services available under Medicare Part B

Name__________________________________          Date _______________

Description	Scheduled	Date done
Influenza Vaccine (annual)
Pneumoccocal Vaccine (once after age 65)
Hepatitis B Vaccine (series of 3, for high risk individuals only)
Screening Gyn Exam with PAP Smear (every 2 years, or annual if high risk)
Screening Mammogram (annual)
Digital Prostate Exam (annual)
Bone Density Screening (allowable every 2 years)
Cardiovascular Screening Blood Tests
Diabetes Screening Tests (if you are at high risk)
Diabetes Outpatient Self-Management Training Services
Medical Nutrition Therapy for Individuals with Diabetes or Renal Disease
Prostate Cancer Screening Test (annual screening PSA level)
Colorectal Cancer Screening Tests: —Annual Stool Hemoccult Testing —Colonoscopy every 10 years

 

                                                  Reviewed with Dr. ____________________________