Preventive Medicine Annual Wellness Visit Form

Transform Your Annual Wellness Visits with Paperform

Annual wellness visits are a cornerstone of preventive medicine, yet many healthcare practices struggle with fragmented intake processes that miss critical screening opportunities and fail to address social determinants of health. Our Preventive Medicine Annual Wellness Visit Form template helps healthcare providers, primary care physicians, family medicine practices, and preventive health clinics deliver comprehensive, patient-centered care while closing care gaps and meeting quality measure requirements.

Why This Template Works for Healthcare Providers

This template goes beyond basic health history collection. It's designed to align with Medicare Annual Wellness Visit requirements and preventive care best practices, incorporating age-specific screening recommendations, advance directive discussions, and social determinants of health assessments—all in one streamlined, professional form.

Whether you're a solo practitioner, part of a multi-physician practice, or managing a community health center, this form helps you:

• Capture complete patient data for annual wellness visits in a structured, compliant format
• Identify care gaps with age-appropriate screening reminders and health maintenance tracking
• Address social needs through validated social determinants of health screening questions
• Document advance care planning conversations to meet CMS and quality reporting requirements
• Streamline documentation by gathering information before the visit, maximizing face-to-face time with patients

Built for Modern Healthcare Workflows

Paperform makes it easy to collect sensitive health information securely while maintaining your practice's professional image. The form integrates seamlessly with your existing EHR systems through Stepper workflows, allowing you to automatically route completed wellness assessments directly into patient charts, trigger follow-up appointment scheduling for needed screenings, or alert care coordinators about identified social needs.

Healthcare practices using this template report significant improvements in preventive care completion rates, better chronic disease management, and enhanced patient satisfaction scores. By identifying medication adherence issues, fall risks, cognitive concerns, and social barriers to care during the annual visit, you can intervene earlier and prevent costly hospitalizations.

Key Features for Preventive Care Excellence

This wellness visit form includes validated screening tools for depression (PHQ-2), cognitive impairment, fall risk assessment, and functional status evaluation. It captures comprehensive medication reconciliation, immunization history, and family health history while documenting advance directive preferences and healthcare proxy information.

The social determinants of health section addresses food insecurity, housing stability, transportation barriers, utility needs, and interpersonal safety—factors that significantly impact health outcomes but are often overlooked in traditional medical assessments.

Seamless Integration with Your Practice Management Tools

Connect this form to your practice management system, EHR, or patient portal using Paperform's native integrations or Stepper workflows. Automatically create tasks for your nursing staff to schedule mammograms, colonoscopies, or other preventive screenings based on patient responses. Send personalized follow-up emails with educational resources about identified health risks, or trigger care coordinator outreach for patients screening positive for social needs.

HIPAA Considerations and Security

While Paperform itself is not HIPAA compliant, it offers SOC 2 Type II certification and robust security features. Many healthcare practices use Paperform for initial patient intake and wellness screening data that doesn't contain protected health information, then transfer relevant details to their HIPAA-compliant EHR systems. For practices requiring full HIPAA compliance for all patient interactions, we recommend consulting with your compliance officer about appropriate use cases and data handling procedures.

Perfect for These Healthcare Professionals

This template is ideal for primary care physicians, family medicine practitioners, internal medicine specialists, geriatricians, nurse practitioners, physician assistants, care coordinators, population health managers, and preventive medicine specialists who want to deliver comprehensive, value-based care.

Healthcare organizations focused on Medicare Advantage, ACO quality measures, HEDIS scores, and patient-centered medical home recognition will find this template invaluable for documenting preventive care delivery and closing gaps in care.

Automate Your Wellness Visit Workflow with Stepper

Take your preventive care program to the next level by connecting this form to Stepper (stepper.io). Automatically score fall risk assessments, flag patients needing depression screening follow-up, generate screening due lists based on age and gender, send lab requisitions for recommended tests, and create care team tasks—all without manual data entry. Stepper's AI-native workflows ensure no preventive opportunity slips through the cracks, helping your practice achieve better outcomes while reducing administrative burden.

Get started with this comprehensive annual wellness visit template today and deliver the proactive, preventive care your patients deserve.