DHHR > HealthCheck > Provider Information

Provider Information 

The HealthCheck Program works to equip West Virginia's Medicaid providers with the necessary tools and knowledge to carry out EPSDT services appropriate to the American Academy of Pediatrics' standard for pediatric preventive health care, Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents.

This section of the web site includes resources and materials which support these standards and are easily accessible.

Provider Information Updates

HealthCheck Preventive Health Screening Form Page 2- Authorization Request (Medical Providers Only)

HealthCheck Health History and Preventive Health Screening Forms: 

Health History Form 0-6 years	Health History Form 7-20 years	1 Day-4 Weeks Form
2 Month Form	4 Month Form	6 Month Form
9 Month Form	12 Month Form	15 Month Form
18 Month Form	24 Month Form	30 Month Form
3 Year Form	4 Year Form	5 Year Form
6 Year Form	7 & 8 Year Form	9 & 10 Year Form
11-14 Year Form	15-17 Year Form	18-20 Year Form

Print all HealthCheck Forms

To order HealthCheck Health History and Preventive Health Screening Forms compete the Materials Request Form, print and fax to: 304-558-1524.