Women's Medicare Health Checkup Template

Medicare Annual Wellness Visit (Female)
Patient Information:
Jane Doe  
Date of Birth: 01/15/1955
Visit Details:
Date of Visit: 08/20/2024  
Reason for Visit: Annual wellness check-up
Health Risk Assessment:
Hypertension: Stable, on Lisinopril 10mg daily, recent blood pressure 130/85 mmHg, last cardiology appointment 07/15/2024.  
Osteoarthritis: Managed with physical therapy, recent X-ray shows mild progression, orthopedic consultation on 08/07/2024.  
Type 2 Diabetes: Controlled, on Metformin 500mg twice daily, HbA1c 6.5% as of 09/01/2024.  
Current health status: Overall stable with controlled chronic conditions.  
Functional ability and level of safety: Independent, no fall risk identified.  
Psychosocial risks: Depression screening negative, cognitive function normal.  
Behavioral risks: Non-smoker, occasional alcohol use.  
Nutrition and physical activity assessment: Balanced diet, regular exercise routine.
Medical History:
Past medical history: Appendectomy in 1980, hysterectomy in 2005.  
Family history: Mother had breast cancer, father had hypertension.  
Current medications: Lisinopril, Metformin, Calcium supplements.  
Allergies: Penicillin.
Preventive Services:
Screening tests due: Mammogram scheduled for 11/05/2024, bone density scan due.  
Immunizations status: Up-to-date, received flu shot on 08/20/2024.
Assessment and Plan:
Assessment: Stable health status, menopause-related symptoms managed.  
Plan: Continue current medications, schedule bone density scan, follow-up in 6 months.  
Referrals: None needed at this time.  
Follow-up appointments: Next wellness visit in April 2025.
Patient Education and Counseling:
Topics discussed: Importance of regular exercise, balanced diet, and managing stress.  
Patient's understanding and agreement: Patient agrees with the plan and understands the importance of preventive care.
Advance Care Planning:
Discussion of advance directives: Patient has a living will and wishes to review it annually.