Healthchek Screening Forms

For fill-in and PDF versions of the following Healthchek Screening Forms,  click here and search for form number: 03518

• Newborn Healthchek-EPSDT
• 4 Week Healthchek-EPSDT
• 2 Month Healthchek-EPSDT
• 4 Month Healthchek-EPSDT
• 6 Month Healthchek-EPSDT
• 9 Month Healthchek-EPSDT
• 12 Month Healthchek-EPSDT
• 15 Month Healthchek-EPSDT
• 18 Month Healthchek-EPSDT
• 24 Month Healthchek-EPSDT
• 30 Month Healthchek-EPSDT
• 3 Year Healthchek-EPSDT
• 4 Year Healthchek-EPSDT
• 5 Year Healthchek-EPSDT
• 6-10 Year Healthchek-EPSDT 
• 11-14 Year Healthchek-EPSDT
• 15-20 Year Healthchek-EPSDT