Worksheets, Forms, and Guides
Preventive Health Tracking Forms
To help your practice achieve its own preventive health goals, we are happy to provide updated versions of our Preventive Health Tracking Forms and Recommended Child Immunization Schedules. These are a reminder to your office staff to provide the appropriate age and gender-specific preventive counseling, screening services, and immunizations.
Pediatric Growth Charts
Monitoring physical growth is fundamental to pediatric health care delivery. This information will support your efforts to provide the best care to children.
Behavioral Health Practitioner Communication Form
This form is intended to give physicians the opportunity to communicate vital information about patients to behavioral health practitioners when referring patients.
Depression/Suicide Overview Guide
The Depression/Suicide Overview Guide offers network providers resources that support clinical practice consistent with nationally recognized standards of care. Individual clinical decisions should be tailored to specific patient medical and psychosocial needs. You can download a copy of this overview guide. This piece is also available to all network providers via our provider supply line at 1-800-858-4728.
Substance-Use Disorders Identification Overview
The Substance-Use Disorders Identification Overview Guide offers network providers resources that support clinical practice consistent with nationally recognized standards of care. Individual clinical decisions should be tailored to specific patient medical and psychosocial needs. You can download a copy of this overview guide. This piece is also available to all network providers via our provider supply line at 1-800-858-4728.
The SWAN Rating Scale for ADHD
According to the American Psychiatric Association, Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most frequently diagnosed psychiatric disorders in children. This tool is provided to aid in the appropriate identification, screening, and care of school-age children and their siblings for ADHD.
Evaluating and Reducing Breast Cancer Risk
Find out about improvements in the Independence Blue Cross Mammography Program and download a monograph that summarizes how to assess an individual woman’s breast cancer risk and determine appropriate cancer risk reduction strategies.
Fracture Risk Assessment Tool
This tool has been developed by the World Health Organization (WHO) to evaluate fracture risk of patients. Use the "Calculation Tool" found in the drop-down menu located at the top of the page. Note: You will be able to choose one of four U.S. tools, including specialized tools for patients of Caucasian, African American, Hispanic, and Asian ethnicities.
