Medicare wellness exam form pdf 2026

1. Click ‘Get Form’ to open the Medicare wellness exam form in our editor.
2. Begin by entering today's date at the top of the form. Fill in your name, medical record number, and date of birth in the designated fields.
3. Complete the initial intake section by providing details about the staff conducting the intake and your last exam date. Ensure you indicate any language or communication barriers.
4. Proceed to fill out your vital signs, including temperature, pulse, respiratory rate, height, weight, BMI, waist measurement, and blood pressure.
5. In the social history section, indicate your tobacco use status and frequency. Provide information on alcohol consumption and any drug abuse history as applicable.
6. Continue with family history by marking any relevant conditions using a checkmark. This includes hypertension, heart disease, and other significant health issues.
7. Document your medical history including hospital visits and surgeries. List any allergies along with their reactions in the allergy list section.
8. Finally, review all sections for accuracy before saving or sharing your completed form directly from our platform.

Start using our platform today to easily fill out your Medicare wellness exam form for free!