Name:

Year:

Health Screening Checklist (Female)

Age 20 and older………………………………………………………………… Frequency Complete Date

Complete Physical Exam Yearly

Cervical Cancer Screening Every 3 years or more often

Pap test based on risk factors

STD Screening If pregnant or high risk

Gonorrhea, Chlamydia, HIV, Syphilis

Skin Cancer Screening Yearly

Visual exam by medical professional

Blood Pressure Check At least once every 2 years

Body Mass Index (BMI) Calculation Yearly

Cholesterol Screening At least once every 5 years

Fasting lipid panel

Dental Cleaning/Exam Every 6 months

Vision/Eye Exam At least once every 2 years

Age 40 and older…………………………………………………………………

Breast Cancer Screening Yearly

Mammogram and clinical breast exam

Diabetes Screening
At least once every 3 years
Fasting blood sugar

Age 50 and older…………………………………………………………………

Colon Cancer Screening At least once, then based on

Colonoscopy, Simoidoscopy or Fecal initial test results
Occult Blood Test

Age 65 and older…………………………………………………………………

Osteoporosis Screening At least once, then based on

Bone Mineral Density Test initial screening results

Created by Renae Wortz, NP-C, 2012. For informational purposes only, not intended to diagnose or treat any illness.
Please discuss individualized screening recommendations with your health care provider.