
WELL VISIT
WELL VISIT
Routinely screens for and prevents problems based upon preventive guidelines.
Routinely screens for and prevents problems based upon preventive guidelines.
We are open for both In Person and Telehealth (portal, telephone, video) visits.
U.S. Preventive Task Force Guidelines
depending upon your age and risk factors
EXAMPLES
PSYCHIATRY
Unhealthy Drug
..opioid, cannabis, stimulant, sedative hypnotic
..tobacco
..alcohol
Depression (Lifeline 800.273.8255, text 998)
Healthy Diet + Physical Activity
CARDIOVASCULAR
Hypertension (annually: age 40+, African, hypertension, overweight/obese; otherwise age 18-39 every 3-5 yrs)
Lipid (age 35+ male, risk factors)
Abdominal Aortic Aneurysm (age 65-75 if ever smoker)
Statin for cardiovascular disease 10 year risk 10+%)
INFECTION
Sexually Transmitted Infection Prevention (safe sex: limit partner, verify status, use condom)
HIV (exposure, age 15-65 x 1+, pregnant, Man Sex with Man HIV+ partner, IV drug use, or transactional/commercial sex, inconsistent condom use when not in a mutually monogamous relationship, every 3-6 mo)
..Pre-Exposure Prophylaxis (PrEP): Man Sex with Man, HIV+ partner, inconsistent condom use, syphilis/gonorrhea/chlamydia within 6 mo)
PrEP reduces relative risk by 54% (73% if compliance is >=70%) so still limit partners, verify status, and use condom
Hepatitis B (exposure, born Asia/Africa, IV Drug Abuse, Men having Sex with Men, pregnant)
Syphilis (exposure, Man Sex with Man, prostitute, HIV+ living partner)
Hepatitis C (age 18-79 x 1+, exposure, born 1945-65, transfuse/transplant, IV Drug Abuse, liver disease)
Chlamydia + Gonorrhea (exposure, female sexually active age <=24 or age 25+ with new/multiple partner(s), symptoms)
Latent Tuberculosis (former resident in country at risk, homeless, prison)
Immunizations (may obtain at pharmacy)
.. Pediatric
..Adult
COVID x 2+ when to get a booster
flu: annual (LIVE VERSION NOT RECOMMENDED FOR PREGNANT or IMMUNOCOMPROMISED), inactive version recommended for immunocompromised)
TDaP: every 10 years
MMR (NOT RECOMMENDED FOR PREGNANT OR IMMUNOCOMPROMISED)
VAR x 2 if no history of vaccination or disease (NOT RECOMMENDED FOR PREGNANT OR IMMUNOCOMPROMISED)
HepB x 3 (if
PCV15 or PCV20 (if age >=age65 and no history of any pneumococcal vaccination, new CDC recommendation)
..Additional Immunizations for Specific Populations
Pregnant: 1 TDaP each pregnancy week 27-36 (CONTRAINDICATED: LIVE FLU, MMR, VAR, HPV SO DO NOT GET)
Immunocompromised: shingles RZV, pneumococcal (CONTRAINDICATED: LIVE FLU, MMR, VAR SO DO NOT GET)
Chronic Liver Disease: hepA
Healthcare Personnel: shingles RZV
Men who have Sex with Men : shingles RZV age 50+, HPV <=age26, monkeypox if exposure https://myturn.ca.gov/
CANCER
Breast Cancer
..mammogram (biennial age 50-74) +/- annual age 40+ (preferred)
if silicone implants, in addition to mammogram with additional views also post-operatively MRI or ultrasound at 5-6 years then every 2-3 years (implant rupture risk during mammography s 1%)
..BRCA gene (also for Ovarian Cancer)
known family BRCA mutation
Ashkenazi Jewish woman: breast or ovarian cancer in 1st degree relative or two 2nd degree relatives
1st degree relative(s) with breast cancer: two relatives or one relative with bilateral
1st or 2nd degree relatives: three with breast cancer or comorbid breast and ovarian cancers or two with ovarian cancer
male family member with breast cancer
..endocrine Rx new including for
age 65+ with 1 first-degree relative with breast cancer
age 45+ with more than 1 first-degree relative with breast cancer or 1 first-degree relative who developed breast cancer before age 50
age 40+ with a first-degree relative with bilateral breast cancer
presence of atypical ductal or lobular hyperplasia or lobular carcinoma in situ on a prior biopsy
Cervical Cancer (every 3 yrs age 21-65; every 5 yrs age 30-65 if Pap and HPV normal)
please reschedule if menstruating and ideally abstain from sex 48 hours prior to pap
Colon Cancer (newly lowered age 45-75, especially black/native, family history, male, obese, diabetes, smoker, alcohol)
..Options
high-sensitivity guaiac fecal occult blood test (HSgFOBT) or FIT fecal immunochemical test annually
stool DNA-FIT (ColoGuard) every 1 to 3 years
virtual colonoscopy (computed tomography colonography) every 5 years
flexible sigmoidoscopy every 5 years
flexible sigmoidoscopy every 10 years + annual FIT
colonoscopy screening every 10 years (preferred)
risk of perforation is 1%
Lung Cancer (updated: age 50-80 + 20 pack yrs + smoker <=15 yrs)
Prostate Cancer (age 55-69) option for annual blood/exam age 50+ (age 35+ if African or family history)
ABUSE
Intimate Partner Violence (childbearing age female)
ENDOCRINOLOGY
Diabetes (age 35-70 overweight/obese, Family History, ethnicity: African, Native, Asian, Hispanic, Pacific Islanders)
Osteoporosis (age 65+ female)
DERMATOLOGY
Skin Cancer if fair skinned (shade 10AM-4PM, cover, SPF 30+)
inform doctor if any suspicious lesions including using ABCDE pneumonic:
Asymmetry, Border irregular, Color black or varying, Diameter >5mm, Evolving/Enlargement/Elevation
PREGNANCY PLANNING
folic acid 400-800ug daily