Children's Preventative Health System Attachments

^Patient

• 39294-4 Children's preventive health services attachment Set form
• 39256-3 History and physical screen assessment Set CPHS form
• 39249-8 Program participation Set CPHS form
• 39185-4 Growth and development (includes speech) screen assessment Set CPHS form
• 39235-7 Immunization data Set CPHS form
• 39193-8 Lead (exposure to) screen assessment Set CPHS form
• 39200-1 Nutrition screen assessment Set CPHS form
• 39204-3 Orthopedic screen assessment Set CPHS form
• 39208-4 Tuberculosis exposure screen assessment Set CPHS form
• 39228-2 Lead screen test status CPHS form
• 39216-7 Other screen assessment Set CPHS form
• 39221-7 Diagnosis recommendations Set CPHS form

Behavior

• 39166-4 Behavioral/mental health screen assessment Set CPHS form

Blood (Bld)

• 39227-4 Hematocrit test status CPHS form
• 39226-6 Hemoglobin test status CPHS form

Cardiovascular system

• 39257-1 Cardiac screen assessment Set CPHS form

Clinical referral

• 39266-2 Follow-up (referred to) provider /specialist Set CPHS form

Dentition

• 39173-0 Dental screen assessment Set CPHS form

Ear

• 39189-6 Hearing screen assessment Set CPHS form

Endocrine system

• 39177-1 Endocrine screen assessment Set CPHS form

Ear, Nose, Throat (ENT)

• 39258-9 ENT screen assessment Set CPHS form

Eye

• 39212-6 Vision screen assessment Set CPHS form

Genitourinary systems

• 39181-3 Genitourinary screen assessment Set CPHS form

Nervous system (Neurologic system)

• 39262-1 Neurologic screen assessment Set CPHS form

Program referral

• 39273-8 Follow-up (referred to) program Set CPHS form

Responsible party

• 39280-3 Responsible party Set CPHS form

Serum or Plasma (Ser/Plas)

• 39229-0 Lipid screen test status CPHS form

XXX

• 39232-4 Screen test, other Set CPHS form