​Encounter Forms

The Maryland Healthy Kids Program Pediatric Visit Sheets (Encounter Forms) document the child/adolescent preventive visit for a specific age. They are designed to capture all components of the EPSDT schedule. The encounter forms are to be used it the provider does not have electronic medical records in place, or, as a template.  To open a document, click on the "X" sign.

 

  
  
  
  
Encounter Form 3 to 5 daysXX2017
Encounter Form 0-1 monthXX2017
Encounter Form 2-3 monthsXX2017
Encounter Form 4-5 monthsXX2017
Encounter Form 6-8 monthsXX2017
Encounter Form 9-11 monthsXX2017
Encounter Form 12-14 monthsXX2017
Encounter Form 15-17 monthsXX2017
Encounter Form 18-23 monthsXX2017
Encounter Form 2 yearsXX2017
Encounter Form 30 monthsXX2017
Encounter Form 3 years XX2017
Encounter Form 4-5 yearsXX2017
Encounter Form 6- 11 yearsXX2017
Encounter Form 12-13 years XX2017
Encounter Form 14-16 yearsXX2017
Encounter Form 17-20 yearsXX2017

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