Title Page: Mission, Vision and Goal |
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Table of Contents - Updated 07/2010 |
Section 1: Introduction Updated 2010 |
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| A. |
Overview |
| B. |
Healthy Kids Program Administration |
| C. |
Provider Certification and Qualifications |
| D. |
Local Health Department Role |
| E. |
Medicaid Managed Care Organizations |
| F. |
Healthy Kids Program Performance Improvement Standards |
| G. |
HIPAA Privacy |
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Addendum - Updated 2010 |
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Provider Certification Requirements Application udated 2012 |
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Provider Certification Letter |
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Provider Action Grid for MCO Newborn Coordinators |
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HIPAA Letter by Maryland Attorney General's Office |
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Top of Page |
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Section 2: Marlyand Preventive Health Care OverviewUpdated 2012 |
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Maryland EPSDT Healthy Kids Preventive Health Schedule .pdf New- effective 1/1/2013 |
| A. |
Initial Screening Services |
| B. |
Periodic Screening Services |
| C. |
Additional Screening Services |
| D. |
Hearing, Vision and Dental Screening Services |
| E. |
Required EPSDT Components of Maryland Healthy Kids Program |
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Top of Page |
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Section 3: Healthy Kids/ EPSDT Screening Components updated 2012 |
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| A. |
Health and Developmental History |
| B. |
Comprehensive Physical Examinations |
| C. |
Laboratory Tests |
| D. |
Immunizations |
| E. |
Health Education /Anticipatory Guidance |
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| Tables and Charts: - Updated 01/09 |
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Table 1 - 3 Pocket Guide to BP Measurement in Children - New 2008 - Blood Pressure Levels for Girls
- Blood Pressure Levels for Boys
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Table 4 - Guidelines for Objective Vision Screening |
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Table 5 - Dietary Fluoride Supplementation Schedule |
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Table 6- Tooth Eruption Charts, Primary and Permanent |
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Table 7 - MD Newborn Metabolic Screen Disorders |
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Table 8 - Hematocrit and Hemoglobin Values for Children |
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Table 9a & 9b - MD Blood Lead Follow-up for Children - Updated 2008 |
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Table 10 - Classification of Cholesterol Levels in Children and Adolescents |
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Table 11 - Follow-up of Average LDL - Cholesterol Determinations |
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Table 12 - Targeted Testing and Treatment of Latent TB Infection (Children) |
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Table 13 - Tuberculin Skin Test Cut - Points by Age for Low Risk Persons |
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Table 14 - Regimens for Treatment of Latent TB Infection |
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Addendum |
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WIC Referral Form - Updated 2010 |
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Maryland Newborn Hearing Screen Guide |
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Developmental Screening Tools - New 2008 |
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Additional Evaluation/Intervention for Developmental Disorders - New 2008 |
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Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity - 2007 - An Implementation Guide from the Childhood Obesity Action Network - New 2010 |
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Web Sites - Updated 2008 |
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Top of Page |
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Section 4: Adolescent Preventive Health - Updated 2010 |
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| A. |
Introduction |
| B. |
Health and Developmental History |
| C. |
Comprehensive Physical Examination |
| D. |
Laboratory Tests |
| E. |
Immunizations |
| F. |
Health Education and Anticipatory Guidance |
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Addendum |
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Bright Futures Adolescent Health Update - New 2010 |
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Identify and Treat Adolescent Depression - New 2010 |
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Teen Screen Brochure PSC-Y - English - New 2010 |
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Teen Screen Modified - Depression - New 2010 |
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Informed Consent and Agreement to HIV Testing |
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Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity - 2007 - Updated 2010 |
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Web Sites - Updated 2008 |
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Top of Page |
Section 5: Other Child Health Services - Updated 2010 |
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| A. |
Expanded EPSDT-Related Services |
| B. |
HealthChoice Self-Referred Services |
| C. |
Children in State-Supervised Care |
| D. |
Other Programs for Children with Special Needs |
| E. |
Dental Care |
| F. |
Specialty Mental Health System |
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Addendum - Updated 2010 |
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Maryland Uniform Consultant Referral Form |
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School-Based Health Center Health Visit Report Form - New 2010 |
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MD Infants and Toddlers Referral and Feedback Form - New 2008 |
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REM Referral Form - Updated 2008 |
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Top of Page |
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Section 6: Billing and Encounter Data Reporting - Updated 2010 |
| A. |
Introduction |
| B. |
Verifying Eligibility |
| C. |
Billing for Fluoride Varnish application as Part of the EPSDT Preventive Care Visit |
| D. |
Billing for Services to Children in MCOs |
| E. |
Billing Medical Assistance for Services to Children Not in an MCO |
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Section 7: Appendices |
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| Appendix I: Preventive Care Forms |
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Medical and Family History Form (English) |
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Medical and Family History Form (Spanish) |
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Age-Specific Encounter Forms - Updated 2012 |
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CDC Growth Charts (2000) |
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Body Mass Index (BMI) Calculator – Child & Teen |
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Objective Hearing and Vision Form |
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Top of Page |
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Appendix II: Risk Assessments Forms |
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Preventive Screen Questionnaire: TB, Lead, Cholesterol and STD/HIV (English) updated 2012 |
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Preventive Screen Questionnaire: Tb, Lead, Cholesterol and STD/HIV (Spanish) |
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Mental Health Questionnaire: Age 3-5 (English) Updated 2010 |
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Mental Health Questionnaire: Age 3-5 (Spanish) Updated 2010 |
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Mental Health Questionnaire: Age 6-9 (English) Updated 2010 |
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Mental Health Questionnaire: Age 6-9 (Spanish) Updated 2010 |
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Mental Health Questionnaire: Age 10-12 (English) Updated 2010 |
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Mental Health Questionnaire: Age 10-12 (Spanish) Updated 2010 |
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Mental Health Questionnaire: Age 13-20 (English) Updated 2010 |
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Mental Health Questionnaire: Age 13-20 (Spanish) Updated 2010 |
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Edinburgh Postnatal Depression Scale (EPDS) - New 2008 |
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CRAFFT Adolescent Substance Abuse Assessment (English) |
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CRAFFT Adolescent Substance Abuse Assessment (Spanish) |
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SEEK Parent Questionnaire (Abuse Assessment) |
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Nutrition Questionnaires (Infant, Child, Adolescent) - Updated 2008 |
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Top of Page |
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Appendix III: Immunization Forms and
Resources - Updated 2008 |
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Recommended Childhood and Adult Immunization Schedules - Updated 2008 |
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Vaccine Administration Record - Updated 2008 |
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VFC Eligibility Screening Record - Updated 2008 |
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Maryland Immunization Certificate - Updated 2008 |
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Vaccine Storage Temperature Log - Updated 2008 |
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VFC Vaccine Inventory Form - Updated 2008 |
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VFC Vaccine Return Form - Updated 2008 |
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Parental Delegation Form for Minors |
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Top of Page |
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Appendix IV: Health Education Materials |
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Food Guide Pyramid |
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General Child Seat Use and MD Child Safety Seat Law |
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National Safe Kids Campaign Materials (Fire, Poison, Home) |
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Communicable Disease Fact Sheet |
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| Order Forms For Educational Materials |
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Medical Assistance Outreach Materials Order Form - Updated 2010 |
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Center for Immunizations |
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Lead Prevention |
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Order Form for WIC Outreach Materials |
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Chronic Disease Prevention Materials |
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CDC Tuberculosis Elimination Materials |
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AIDS Administration - HIV Prevention |
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Top of Page |
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Section 8: Telephone Directories - New 2008 |
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Healthy Kids Program Consultants - Updated 2012 |
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Medicaid Administration and Billing Contacts |
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HealthChoice Managed Care Organization Resource List - Updated 2008 |
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Substance Abuse MCO Referral Information - Updated 2008 |
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MCO Pharmacy Services and Contacts - Updated 2010 |
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Maryland VFC Program Consultants |
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Rare and Expensive Case Management (REM) - Updated 2008 |
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Local Infants and Toddlers Program - Updated 2008 |
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Child Find Program |
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Local Health Department Programs - Updated 2008 |
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Transportation Contacts |
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Maryland WIC Agencies - Updated 2008 |
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Domestic Violence Programs |
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MD and Local DHR Local Child Protective Services |
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Head Start Centers of MD |
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Top of Page |