Physical measures:

BMI: Every visit

Blood Pressure: Every visit

Breast/pelvic/genital exam: Only to monitor transition-related changes or to f/u on HPI complaints. Self-
exam for cancer screening of breasts or testes is not recommended.

Audiometry: once 11-14yo, 15-17yo, and 18-21yo

Vision: 10yo, 12yo, 15yo

Full physical exam: Annually and to f/u on HPI complaints. Scoliosis screening is indeterminate
recommendation.

Questions (HEADSS+):

SOGI: Recommend regular check in on SOGI as identities can change. Complete EPIC fields.

Acne: Location, type, treatment

Early cardiac death hx/sports tolerance: Family history of early cardiac death, cardiac anomalies,
personal cardiac hx

Menarche: Onset, cramping – loss school days?, anemia sxs, regularity/PCOS

Substance use: What (including party drugs ie poppers, E, crystal, illicit hormones/testosterone), how
often, methods (IV, intranasal), sex under the influence, car under the influence, CRAFFT, treatment
desired?

Violence: weapons/firearms, experience sexual or physical or mental abuse, bullying/cyberbullying,

gangs, sex work violence

Living conditions: at home/shelter/homeless, who is at home, home safety, shares a room

Mental health: PHQ-9, GAD-7, depression, anxiety, PTSD, ADHD, suicide

Dental: Recommend every 6mo-1yr visits

Offer PEP/PrEP: Risky sexual behaviors – serodiscordance, multiple sexual partners, injection drug user,
frequent STIs, partner HIV status unknown; risk exposure – shared needles or other drug preparations
for injection, sexual assault, sex exposure like broken condom or BB

 PrEP screener:
 Do you use condoms sometimes or not at all?
 Do you get often get STIs in your butt?
 Do you often get STIs in your vagina?
 Have you taken post-exposure prophylaxis (PEP) more than once in the past year?
 Are you in a serodiscordant relationship, where your sexual partner is HIV positive and you are
HIV negative?
 Are you in an open relationship or having anal and/or vaginal sex with multiple partners?
 Are you having sex with someone whose HIV status you don’t know?
PEP screener:

If you’re HIV-negative or don’t know your HIV status, and in the last 72 hours you

1. think you may have been exposed to HIV during sex (for example, if the condom broke),
2. shared needles and works to prepare drugs (for example, cotton, cookers, water), or
3. were sexually assaulted,

Education/Employment: sex work, school completion

Anticipatory guidance: Relationships, organizing life, enjoyable activities, screen time, driving, sex
readiness, stress, decision making,

Personal number or contact

Vaccines:

Flu: Annual – Oct - Mar

HPV: 9-26yo, typically started at 11yo. If first vaccine given before 15yo – 2 doses (6mo apart minimum)
only needed. If after or immunocompromised including HIV, then 3 doses (0mo, 2mo, 6mo minimum).
Do not need to restart series if delayed. Use directed language – not opt in.

Meningococcal ACWY: 11yo #1, 16yo #2, repeat every 5 years (21yo) if military recruit or
continuing to live in school residential housing
Tdap: 11yo, 19-21yo, repeat q10yrs (if no documentation ie immigrant, administer first dose anytime)

Pneumococcal: immunocompromised state = sickle cell w/ asplenia, HIV, asthma on ICS – give PCV13
then PPSV23 after 8wks then PPSV23 in 5yrs

 No history of either PCV13 or PPSV23: 1 dose of PCV13, 2 doses of PPSV23 (1st dose of PPSV23
administered 8 weeks after PCV13 and 2nd dose of PPSV23 administered at least 5 years after the 1st
dose of PPSV23).
 Any PCV13 but no PPSV23: 2 doses of PPSV23 (1st dose of PPSV23 to be given 8 weeks after the most
recent dose of PCV13 and 2nd dose of PPSV23 administered at least 5 years after the 1st dose of
PPSV23).
 PPSV23 but no PCV13: 1 dose of PCV13 at least 8 weeks after the most recent PPSV23 dose and a 2nd
dose of PPSV23 to be given 5 years after the 1st dose of PPSV23 and at least 8 weeks after a dose of
PCV13.
Meningococcal B: sickle cell w/ asplenia (if not previously documented)
HIB: sickle cell w/ asplenia (if not previously documented)

Labs (need to check EPIC orders):

Hep A IgG: if negative, vaccinate 1 dose. If no vaccine or ab documented but traveling to endemic area,
vaccinate 1 dose.

Hep B s ab/ag, hep b c ab: If hep b s ab neg, vaccinate w/ 3 doses (0mo, 1-2mo, 6mo). 11-15yo can use
2-dose schedule (0, 4mo) of adult reombivax HB only.

Hep C ab: can repeat PRN risk

MMR/V: recommend one time lab for e/o immunity; revaccinate if not documented (check CIR) or
no lab e/o immunity unless pregnant (must wait until after pregnancy) or certain
immunocompromised state - MMR is one dose, V is 2 4-8wks apart
HIV screening ab/ag: q3mo or PRN risk

STI screening: triple site screening oral/anal/genital (urine), q3mo or PRN risk

CBC:

Lipids: annually on hormones? AAP recommends once from 9-11yo and again at 17-21yo, adult
recommendation is to screen if risk factor: BMI >25, elevated blood pressure, pre-DM.

Pap smear: starting age 21 only.

https://www.aap.org/en-us/Documents/periodicity_schedule.pdf

https://brightfutures.aap.org/materials-and-tools/tool-and-resource-kit/Pages/adolescence-
tools.aspx
https://www.aap.org/en-us/Documents/substance_use_screening_implementation.pdf

Violence:
https://www.aafp.org/afp/2012/1215/p1109.html
http://pediatrics.aappublications.org/content/124/1/393

https://men.prepfacts.org/the-questions/

UTD:
https://www.uptodate.com/contents/guidelines-for-adolescent-preventive-services

CDC Vaccine schedule (2018):

https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-indications.html
https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf
https://www.cdc.gov/hpv/hcp/2-dose/clinician-faq.html
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#f5

HPV vaccine:
https://www.cdc.gov/mmwr/volumes/65/wr/mm6549a5.htm
HAV:
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htm

https://www.uspreventiveservicestaskforce.org/BrowseRec/Index

Bright futures:
https://brightfutures.aap.org/materials-and-tools/PerfPrevServ/Pages/default.aspx
https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_POCKETGUIDE.pdf
https://brightfutures.aap.org/materials-and-tools/Pages/Presentations-and-Handouts.aspx

http://transhealth.ucsf.edu/trans?page=guidelines-home

HIV screening recommendation:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

STI screening:
https://www.cdc.gov/std/tg2015/specialpops.htm

https://www.wpath.org/media/cms/Documents/Web%20Transfer/SOC/Standards%20of%20Care%20V7
%20-%202011%20WPATH.pdf

http://pediatrics.aappublications.org/content/130/2/353

https://jamanetwork.com/journals/jama/article-abstract/2542617
https://www.aafp.org/afp/2016/1215/od1.pdf

http://www.aapd.org/media/Policies_Guidelines/G_Periodicity.pdf