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WCC/AG/HEBA

Well Check Packets for Provider Documentation in LLEAP

English
  
Spanish
HEBA/TB     HEBA/TB  

Birth - 1 mo. 

1 - 2 mos. 

3 - 4 mos.

5 - 6 mos.

7 - 9 mos.

10 - 12 mos.

13 - 15 mos.

16 - 23 mos.

2 years 

3 years 

4 years 

5 years  

6 - 8 yrs.

9 - 11 yrs.

12 years 

13 - 16 yrs.

17 years 

18 - 20 yrs.

21+ years 

56+ years / Seniors

 

Birth - 1 mo.

1 - 2 mos.

3 - 4 mos.

5 - 6 mos.

7 - 9 mos.

10 - 12 mos.

13 - 15 mos.

16 - 23 mos.

2 years 

3 years 

4 years 

5 years 

6 - 8 yrs.

9 - 11 yrs.

12 years 

13 - 16 yrs.

17 years 

18 - 20 yrs.

21+ years

56+ years / Seniors

Medicare Wellness Visit Packet  |  Men's Preventive Plan  |  Women's Preventive Plan

Well Check Packets for Provider Documentation on Paper

 

English
  
Spanish
HEBA/TB None   HEBA/TB None

Birth - 1 mo. 

1 - 2 mos. 

3 - 4 mos.

5 - 6 mos.

7 - 9 mos.

10 - 12 mos.

13 - 15 mos.

16 - 23 mos.

2 years 

3 years 

4 - 5 yrs.

6 - 8 yrs.

9 - 11 yrs.

12 years 

13 - 16 yrs.

17 years 

18 - 20 yrs.

21+ years

Birth - 1 mo. 

1 - 2 mos.

3 - 4 mos.

5 - 6 mos.

7 - 9 mos.

10 - 12 mos.

13 - 15 mos.

16 - 23 mos.

2 years 

3 years 

4 - 5 yrs.

6 - 8 yrs.

9 - 11 yrs.

12 years 

13 - 16 yrs.

17 years 

18 - 20 yrs.

21+ years

 

Birth - 1 mo.

1 - 2 mos.

3 - 4 mos.

5 - 6 mos.

7 - 9 mos.

10 - 12 mos.

13 - 15 mos.

16 - 23 mos.

2 years 

3 years 

4 - 5 yrs.

6 - 8 yrs.

9 - 11 yrs.

12 years 

13 - 16 yrs.

17 years 

18 - 20 yrs.

21+ years

Birth - 1 mo.

1 - 2 mos.

3 - 4 mos.

5 - 6 mos.

7 - 9 mos.

10 - 12 mos.

13 - 15 mos.

16 - 23 mos.

2 years 

3 years 

4 - 5 yrs.

6 - 8 yrs.

9 - 11 yrs.

12 years 

13 - 16 yrs.

17 years 

18 - 20 yrs.

21+ years

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