Ages 40 to 64 Years

Height and weight, BMIPeriodic Screening
Blood PressureAt least every 2 years
8Pap Test
At least every 3 years
12Total Cholesterol screening (for women beginning at 45 years and men beginning at 35 years)Every 5 years
Mammogram or mammogram with annual clinical breast exam Women age 40 years and older.
Every 1-2 years
7Chlamydia screeningRoutine for high risk. Discuss with patient
Fecal Occult Blood testing (beginning at age 50),  Flexible Sigmoidoscopy (beginning at age 50), Colonoscopy(beginning at age 50)Fecal Occult Blood annually Sigmoidoscopy every 5 years  Colonoscopy every 10 years Discuss test method and interval with patient.
Rubella serology or vaccination(women of childbearing years without proof of immunity/ immunization)Once
3Varicella (high risk if not previously immunized) 2 doses – 4-8 weeks apart.
14Td boosterOnce every ten years
13 MMR vaccine (individuals without proof of immunity or if no previous 2nd dose)One dose if measles, mumps, or rubella vaccination history is unreliable.  Two doses for persons with occupational or other indications
6Influenza vaccine (beginning at age 50 and all high risk individuals)Annually in Fall or Winter
2Hepatitis B (high risk individuals, if not previously immunized) At current visit,  second dose at 4 weeks after first dose, third dose at 8 weeks after second dose
11Hepatitis A (high risk individuals, if not previously immunized.)2 doses at least 6 months apart

Additional Recommendations
Physicians discuss with their female patients about taking 400 micrograms of folic acid to decrease the risk for fetal birth defects of the brain or spine.
Pre-conception counseling
9TB Screening – To be performed for high-risk population and in accordance with state law.
Obesity – offer intensive counseling and behavioral interventions to promote sustained weight loss.
Depression Screening –  High risk population
Domestic Violence screening
17Meningococcal:  The CDC recommends vaccination for high-risk populations. 
Peri-menopausal and menopausal women should be counseled about the risk factors for osteoporosis and symptoms of menopause and the benefits and risks of  hormone replacement therapy.

Physicians should discuss risk factors for stroke and coronary artery disease for prevention.

Men should be counseled about the known risks and benefits of prostate cancer screening. African-American men are at increased risk.

Nutrition with counseling to maintain caloric balance, Injury Prevention, Seat Belt Use, Patient Safety, Substance Avoidance (Tobacco, Alcohol, drugs), Sexually transmitted diseases, HIV preventive education, Hormone Replacement, Dental Health, Mental Health (Depression), Regular Physical Activity to prevent coronary artery disease, hypertension, obesity and diabetes



1.Hematocrit See AAP Nutrition Handbook (1998) for a discussion of universal and selective screening options. Consider earlier screening for high-risk infants (e.g. premature and low birth weight). See also Recommendations to Prevent and Control Iron Deficiency in the United Sates. MMWR. 1998: 47 (RR-3): 1-29.

14.Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15 to `18 months. The final dose in the series should be given at age >4 years.

11.Hepatitis A vaccine is recommended for children and adolescents in selected states and regions and for certain high-risk groups; consult your local public health authority. Children and adolescents in these states, regions and high-risk groups who have not been immunized against hepatitis A can begin the immunization series during any visit. The 2 doses in the series should be administered at least 6 months apart. See MMWR 1999; 48(RR-12); 1-37

3.Varicella vaccine is recommended at any visit on or after the first birthday for susceptible children, i.e., those who lack a reliable history of chickenpox and who have not been immunized. Susceptible persons age 13 or older should receive two doses at least 4 weeks apart.

17.Meningococcal vaccine CDC recommendations are for routine immunization for patients age 11years and for patients age 15 years who have not been previously vaccinated. Immunization also recommended for high risk patients including: college freshman living in dormitories, microbiologists who are routinely exposed to N. meningitdis isolates, military recruits, persons living in or traveling to countries in which N. meningitdis is hyperendemic or epidemic, persons who have terminal complement deficiencies, persons who have anatomic or functional asplenia. MMWR May 27, 2005. Volume 54, No. RR-7 (1-17).

16.Pneumococcal vaccine. The Heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children age 2 to 23 months. It is also recommended for certain children age 24 to 59 months. The final dose in the series should be given at age >12 months.

2.Hepatitis B (HepB) vaccine. All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge; the first dose may also be given by age 2 months if the infant’s mother is hepatitis B surface antigen (HBsAg) negative. Only monovalent HepB can be used for the birth dose. Monovalent or combination vaccine containing HepB may be used to complete the series. Four doses of vaccine may be administered when a birth dose is given. The second dose should be given at least 4 weeks after the first dose, except for combination vaccines, which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 24 weeks.

6.Influenza vaccine. For Children and Adolescents influence vaccine is recommended annually for children aged ≥6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV and diabetes. In addition, healthy children ages 6-23 months and close contacts of healthy children ages 0-23 months are recommended to receive influenza vaccine, because children in this age group are at substantially increased risk for influenza-related hospitalizations. Children receiving trivalent inactivated influenza vaccine (TIV) should be administered a dosage appropriate for their age (0.25 mL if 6-35 months or 0.5 mL if ≥3 years). Children aged ≤8 years who are receiving influenza vaccine for the first time should receive 2 doses (separated by at least 4 weeks for TIV and at least 6 weeks for live, attenuated influenza vaccine [LAIV]).

9.Tuberculosis screening – The AAFP strongly recommends screening for tuberculosis by applying the mantoux test to patients at high risk for tuberculosis, including those with close contacts to a person with known or suspected TB, health care workers, immigrants from countries with high TB prevalence, HIV positive individuals, alcoholics, injection drug users, residents of long term care facilities, and medically underserved low income people.

13.Measles, mumps and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4 to 6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11 to12 year old visit.
Measles Component: Adults born before 1957 may be considered immune to measles. Adults born in or after 1957 should receive at least one dose of MMR unless they have a medical contraindication, documentation of at least one dose or other acceptable evidence of immunity. A second dose of MMR is recommended for adults who are recently exposed to measles or in an outbreak setting; were previously vaccinated with killed measles vaccine; were vaccinated with an unknown vaccine between 1963 and 1967; are students in post-secondary educational institutions; work in health care facilities; plan to travel internationally.

7.Chlamydia Routine screening is recommended for all sexually active female age 25 and younger, and other asymptomatic women at high risk of infection (new or multiple partners, history of sexually transmitted diseases, inconsistent or incorrect use of condoms). Pregnant women at high risk of infections (including age 25 and younger) should be tested, timing is uncertain. There is insufficient evidence to recommend for or against screening all women during pregnancy. See Centers for Disease Control and Prevention. Recommendations for the Prevention and Management of Chlamydia Trachomatis Infections, 1993. MMWR 1993; See also CDC Treatment of Sexually Transmitted Disease Guidelines 1998.

8.Cervical Cancer: AAFP strongly recommends routine screening with Papanicolaou (Pap) testing be performed at least every 3 years for all women who have ever had sex and have a cervix.


Total Cholesterol Screening –AAFP strongly recommends screening for lipid disorders with either a fasting
lipid profile or nonfasting total cholesterol and HDL cholesterol in males age 35 and older, and females age 45 and older.


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