EPSDT Forms and Submissions

10/30/2023

An updated version of the EPSDT / Well-Child Visits - Clinical Sample Template is now available. 

Timely submission of EPSDT/Well-Child visit forms is very important to member care coordination. 

Submitting the visit forms to the Health Plan soon after the well-child visit allows us to: 

• Outreach to members and caregivers, evaluate for and mitigate potential barriers to care
• Identify, follow-up and facilitate referrals initiated during the well-child visit

Learn more about how to submit your EPSDT forms or EHRs after a visit below:

• EPSDT/Well-Child Visits - Clinical Sample Template