Kan be healthy form 2026

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4.8 out of 5

118 votes

The KAN Be Healthy (EPSDT) Screening Form is a comprehensive health assessment tool for children aged 6 to 72 months. It includes sections for physical growth measurements, beneficiary and family history, body systems evaluation, vision and hearing screenings, nutrition and physical activity assessments, laboratory tests, immunizations, developmental/emotional evaluations, dental care information, and health education guidance. The form also mandates a separate blood lead screening questionnaire to identify potential lead exposure risks.

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Click ‘Get Form’ to open the kan be healthy form in the editor.
Begin by entering the I.D. Number at the top of the form, followed by the patient's Name, Date of Birth, Age, and Date of Screen.
In the PHYSICAL GROWTH section, input measurements for Weight, Length (for children under 24 months), Standing Height (for ages 2-20 years), and BMI. Ensure to update the Growth Chart as required.
Proceed to the BENEFICIARY & FAMILY HISTORY section. Fill in any present concerns and review previous medical history as indicated.
Complete the BODY SYSTEMS section by marking WNL (within normal limits) or ABN (abnormal) for each system listed and provide comments on any abnormal findings.
Continue through sections on NUTRITION, PHYSICAL ACTIVITY, LABORATORY, IMMUNIZATIONS, DEVELOPMENTAL / EMOTIONAL observations, DENTAL health, HEARING SCREEN results, and HEALTH EDUCATION topics. Make sure to circle those reviewed or handouts given.
Finally, sign off on the RESULTS/PLAN OF CARE section with your signature and date before saving or sharing your completed form.

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