Preventive Services Recommended by the USPSTF 2006

On this date:

Men

1. Abdominal Aortic Aneurysm:  History of Smoking? Yes Maybe No Age 65-75? Yes Maybe No Need AAA screen? Yes Maybe No

2. If you smoke, quantify your tobacco use:

2. History of Alcohol Misuse? Yes Maybe No

3. Do you use aspirin for the primary prevention of cardiovascular events? Yes Maybe No

4. Colorectal Cancer Screening: 

Any personal history? Yes Maybe No   Any family history? Yes Maybe No

Prior Colonoscopy? Yes Maybe No   Results:

Next Colonoscopy due:

5. Any history of depression? Yes Maybe No On any medications in the past? Yes Maybe No Now? Yes Maybe No

6. Any history of diabetes? Yes Maybe No

7. Any history of high blood pressure (hypertension)? Yes Maybe No

8. Do you have high cholesterol? Yes Maybe No

Date of last lipid profile:

Results (Total Cholesterol/Triglyceride/HDL/LDL):

 9. Any history of HIV? Yes Maybe No Syphilis? Yes Maybe No

10. Diet, Behavioral Counseling in Primary Care to Promote a Healthy Life

Other:

*Prostate: Date of last PSA: Result:

*Thyroid: Date of last TSH: Result:

Adult Vaccines

Tetanus: Yes Maybe No Date:
Pneumovax? Yes Maybe No Date:
Annual Flu? Yes Maybe No Date:

* Prostate Cancer, Screening:  The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using PSA or DRE. Rating I Recommendation.

* Thyroid Disease, Screening: The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for thyroid disease in adults. Rating I Recommendation.