Maryland primary care medicare annual wellness 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information at the top, including your name and date of birth. This ensures that your responses are accurately linked to your medical records.
3. Proceed to the Fall Risk Screening section. Answer the questions regarding your fear of falling and any past incidents by checking 'Yes' or 'No' as applicable.
4. In the Depression Screening section, respond to each statement by selecting a number from the provided scale that best reflects your feelings over the past week.
5. Continue through the Home Safety Checklist, marking options that apply to your living situation. This helps assess potential risks in your home environment.
6. Fill out sections on Current Medical Problems and Past Medical History, providing details about medications and any assistive devices you use.
7. Complete the Social History section by indicating whether you need help with routine tasks, ensuring a comprehensive overview of your daily living needs.
8. Finally, review all entries for accuracy before signing and dating the document at the bottom. This confirms that all information is correct and complete.

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