Job & Family Services Ohio Medicaid

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