Availity Portal
Find important self-service tools exclusively at www.availity.com.
Access is managed by your organizations Availity Administrator.

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Medical Policy and Clinical UM Guidelines

View our medical policies and clinical UM guidelines

Need to find a Doctor or Hospital? Check the Online Provider Directory.

Preventive Care Forms

PW_A134092

Preventive Care Forms

The following forms are provided: 

Chart - Under One Month (1/01/07)

Chart - 1 to 2 Months (1/01/07)

Chart - 3 to 4 Months (1/01/07)

Chart - 5 to 6 Months (6/28/07)

Chart - 7 to 9 Months (6/28/07)

Chart - 10 to 11 Months (6/28/07)

Chart - 12 to 15 Months (6/28/07)

Chart - 16 to 23 Months (6/28/07)

Chart - 2 Years (6/28/07)

Chart - 3 Years (6/28/07)

Chart - 4 to 5 Years (6/28/07)

Chart - 6 to 8 Years (1/01/07)

Chart - 9 to 12 Years (1/01/07)

Chart - 13 to 16 Years (1/01/07)

Chart - 17 to 20 Years (1/01/07)

Chart - 21 to 39 Years (Female) (1/01/07)

Chart - 21 to 39 Years (Male) (1/01/07)

Chart - 40 to 49 Years (Female) (1/01/07)

Chart - 40 to 49 Years (Male) (1/01/07)

Chart - 50+ (Female) (1/01/07)

Chart - 50+ (Male) (1/01/07)

 
Note: Documents are in MS Word format.  
 
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