When this form is completely Filled out use EPSDT Screening Code: 99382 – New Patient (ages 1 – 4 years[removed]Established Patient (ages 1 – 4 years) - EPSDT - Document - PDFSEARCH.IO

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	When this form is completely Filled out use EPSDT Screening Code: 99382 – New Patient (ages 1 – 4 years[removed]Established Patient (ages 1 – 4 years) Add to Reading List Document Date: 2014-04-15 17:20:00 Open Document File Size: 41,50 KB Share Result on Facebook MedicalCondition choking / Age_________Allergies / Yes___________________________ FH heart disease / / MedicalTreatment Immunization / Immunizations / / Position *Head / Historian / forward / / SocialTag Huntingtin Milk Federal assistance in the United States United States Department of Agriculture WIC

When this form is completely Filled out use EPSDT Screening Code: 99382 – New Patient (ages 1 – 4 years[removed]Established Patient (ages 1 – 4 years)Add to Reading List