Required documentation for an initial annual wellness visit
| Demographic data |
| Self-assessment of health status |
| Psychosocial risks |
| Behavioral risks |
| Activities of daily living |
| Instrumental activities of daily living |
| Updated personal and family history |
| Substance use disorder assessment |
| List of current health care providers and suppliers |
| Documentation of weight, height, body mass index, and blood pressure |
| Detection of cognitive impairment during visit (direct observation or third-party information helps) |
| Depression screening |
| Functional ability and level of safety (ability to successfully perform activities of daily living, fall risk assessment, hearing impairment screening, home safety assessment) |
| Update all screenings recommended by US Preventive Services Task Force and vaccines recommended by US Centers for Disease Control and Prevention |
| Action plan for any identified risks |
For more detailed information see: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf