• English
    X

    Google Translate Disclaimer

    The Maryland Department of Information Technology (“DoIT”) offers translations of the content through Google Translate. Because Google Translate is an external website, DoIT does not control the quality or accuracy of translated content. All DoIT content is filtered through Google Translate which may result in unexpected and unpredictable degradation of portions of text, images and the general appearance on translated pages. Google Translate may maintain unique privacy and use policies. These policies are not controlled by DoIT and are not associated with DoIT’s privacy and use policies. After selecting a translation option, users will be notified that they are leaving DoIT’s website. Users should consult the original English content on DoIT’s website if there are any questions about the translated content.

    DoIT uses Google Translate to provide language translations of its content. Google Translate is a free, automated service that relies on data and technology to provide its translations. The Google Translate feature is provided for informational purposes only. Translations cannot be guaranteed as exact or without the inclusion of incorrect or inappropriate language. Google Translate is a third-party service and site users will be leaving DoIT to utilize translated content. As such, DoIT does not guarantee and does not accept responsibility for, the accuracy, reliability, or performance of this service nor the limitations provided by this service, such as the inability to translate specific files like PDFs and graphics (e.g. .jpgs, .gifs, etc.).

    DoIT provides Google Translate as an online tool for its users, but DoIT does not directly endorse the website or imply that it is the only solution available to users. All site visitors may choose to use alternate tools for their translation needs. Any individuals or parties that use DoIT content in translated form, whether by Google Translate or by any other translation services, do so at their own risk. DoIT is not liable for any loss or damages arising out of, or issues related to, the use of or reliance on translated content. DoIT assumes no liability for any site visitor’s activities in connection with use of the Google Translate functionality or content.

    The Google Translate service is a means by which DoIT offers translations of content and is meant solely for the convenience of non-English speaking users of the website. The translated content is provided directly and dynamically by Google; DoIT has no direct control over the translated content as it appears using this tool. Therefore, in all contexts, the English content, as directly provided by DoIT is to be held authoritative.

    ​PROVIDER MANUAL

     

      
      
      
      
    Title PageMISSION & GOAL OF THE PROGRAM12021
    Section 1INTRODUCTION: MARYLAND HEALTHY KIDS/EPSDT PROGRAM1.02021
    AOverview1.12021
    BHealthy Kids Program Administration1.22021
    CProvider Certification & Qualifications1.32021
    DLocal Health Departments' Role1.42021
    EManaged Care Organizations1.52021
    FHealthy Kids Program Performance Improvement Standards1.62021
    GHIPAA Privacy1.72021
    Section 1ADDENDUM1.802021
    1.1Provider Application for Certification & Participation1.812021
    Section 2MARYLAND EPSDT PREVENTIVE HEALTH CARE SCHEDULE2.002020
    AInitial Screening Services2.12021
    BPeriodic Screening Services2.22021
    CAdditional Screening Services2.32021
    DHearing, Vision & Dental Screening Services2.42021
    Section 2ADDENDUM: MARYLAND HEALTHY KIDS PREVENTIVE HEALTH SCHEDULE2.62020
    Section 3 HEALTHY KIDS SCREENING COMPONENTS3.002017
    AHealth and Developmental History3.12016
    BComprehensive Physical Examination Requirement3.22016
    CLaboratory Tests3.32016
    DImmunizations3.42017
    EHealth Education Anticipatory Guidance3.52016
    Section 3CHARTS AND TABLES3.62016
    Chart 1Primary Teeth Eruption3.612015
    Chart 2Permanent Tooth Eruption3.622015
    Table 1Girls Systolic BP by Age & Height3.642015
    Table 2Boys Systolic BP by Age & Height3.652015
    Table 3Dietary Fluoride Supplement Dosage Schedule3.662014
    Table 4DHMH List of Disorders on the Newborn Screen3.672016
    Table 5Hematocrit & Hemoglobin Values for Children3.682015
    Table 6MD Elevated Blood Lead Diagnostic & Follow-up Schedule for Children3.692014
    Table 7MD Department of Environment: Case Coordination Guidelines for Lead Poisoned Children3.702014
    Table 8Targeted Testing & Treatment of Latent TB Infection3.712014
    Table 9Tuberculin Skin Test Cut-Points by Age for Low Risk Persons3.722014
    Table 10Regimens for Treatment of Latent TB Infections3.732014
    Table 11Classification of Cholesterol Levels in Children and Adolescents3.742014
    Section 3ADDENDUM3.752016
    3.1Developmental Screening Tools3.762014
    3.2Additional Evaluation & Intervention for Developmental Disorders3.772014
    3.3Modified Checklist for Autism in Toddlers-Revised, with Follow up (MCHAT-R/F)3.7712015
    3.4Early Hearing Detection & Intervention Guide3.782015
    3.5Jaeb Visual Acuity Screener3.7812016
    3.6MD WIC Program Medical Documentation Form3.82015
    3.7Expert Committee Recommendations for the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity-2007-An Implementation Guide from the Childhood Obesity Action Network3.812007
    Section 4ADOLESCENT PREVENTIVE HEALTH4.02016
    AA. Introduction4.12016
    BB. Health and Developmental History4.22015
    CC. Comprehensive Physical Examination4.32015
    DD. Laboratory Tests4.42016
    EE. Immunizations4.52016
    FHealth Education and Anticipatory Guidance4.62015
    Section 4ADDENDUM4.802015
    4.1HEEADSSS Psychosocial Interview4.812015
    4.2Identify and Treat Adolescent Depression4.822010
    4.3Patient Health Questionnaire Modified for Teens (PSC-Y)4.832015
    4.4Pediatric Symptoms Checklist for Teens (PHQ-9 Modified)4.842015
    4.5Informed Consent to HIV Testing (English & Spanish)4.852007
    Section 5OTHER CHILD HEALTH-RELATED SERVICES5.002016
    AExpanded EPSDT-Related Services5.12016
    BHealthChoice Self-Referred Services5.22016
    CChildren in State-Supervised Care5.32016
    DOther Programs for Children5.42016
    EDental Care5.52015
    FPublic Mental Health System (PMHS)5.62016
    Section 5ADDENDUM5.72020
    5.1Maryland Uniform Consultation Referral Form5.712015
    5.2School-Based Health Center Health Visit Report Form5.722015
    5.3Local Infants and Toddlers Referral and Feedback Form5.732009
    5.4Local Health Services Request Form5.742015
    5.5Instructions for Use of Local Health Services Request Form5.752015
    5.6REM Intake Application5.772015
    Section 6BILLING AND ENCOUNTER DATA REPORTING6.002017
    AIntroduction6.12015
    BEligibility Verification6.22015
    CGeneral Rules for Medical Assistance Billing6.32016
    DBilling for Fluoride Varnish Application as Part of the EPSDT Preventive Care Visit6.42016
    EBilling for Vaccines for Children Program6.52017
    FBilling for Services in State-supervised Care6.62015
    GBilling for Services to Children in Managed Care Organizations (MCOs)6.72015
    HBilling for Services to Children Non in MCO (Fee-For-Service)6.82017
    ICMS-1500 Billing Instructions6.92016
    Section 7APPENDICES7.002016
    7.1APPENDIX: PREVENTIVE CARE FORMS7.12015
    7.1.1Age Specific Encounter Forms7.122014
    7.1.2Body Mass Index (BMI) Calculator-Child and Teen7.132016
    7.1.3WHO & CDC Growth Charts7.132014
    7.1.4Medical Family History Questionnaire (English)7.142006
    7.1.5Medical Family History Questionnaire (Spanish)7.152006
    7.1.6Objective Hearing and Vision Testing Forms7.162016
    7.2APPENDIX:RISK ASSESSMENT FORMS7.22016
    7.2.1CRAFT Adolescent Substance Abuse Assessment (English)7.222019
    7.2.2CRAFT Adolescent Substance Abuse Assessment (Spanish)7.2212019
    7.2.3Mental Health Questionnaires (English & Spanish)7.32014
    7.2.4Nutrition Questionnaires (Infant, Child, Adolescent)7.42014
    7.2.5Preventive Screen Questionnaire: Lead, TB, Anemia, Cholesterol & STD/HIV (English)7.52017
    7.2.6Preventive Screen Questionnaire: Lead, TB, Anemia, Cholesterol & STD/HIV (Spanish)7.512017
    7.2.7SEEK Questionnaire (Abuse Assessment) (English)7.62014
    7.2.8SEEK Questionnaire (Abuse Assessment) (Spanish)7.612014
    7.2.9Victimization Scale (English)7.72015
    7.2.10Victimization Scale (Spanish)7.712015
    7.3APPENDIX: IMMUNIZATION FORMS & RESOURCES7.82017
    7.3.1Maryland Immunization Certification Form7.822014
    7.3.2Maryland Recommended Childhood & Adolescent Immunization Schedules7.832019
    7.3.3Maryland Combination Vaccines Schedule7.842017
    7.3.4Parental Delegation Form for Minors7.852015
    7.3.5VFC Vaccine Inventory Form7.862015
    7.3.6VFC Log of Children Receiving VFC Vaccines7.872013
    7.3.7Patient Eligibility Screening Record7.882015
    7.3.8VFC Program Contact Center7.892016
    7.3.9VFC Vaccine Administration Record7.92017
    7.3.10VFC Vaccine Return & Wastage Form7.912015
    7.3.11Temperature Log for Refrigerator-Celsius7.922017
    7.3.12Temperature Log for Refrigerator-Fahrenheit7.92.12017
    7.3.13Temperature Log for Freezer-Celsius7.92.22017
    7.3.14Temperature Log for Freezer-Fahrenheit7.92.32017
    7.4APPENDIX: HEALTH EDUCATION MATERIALS7.932017
    7.4.1Zika-Information-Flyer7.942017
    7.4.2MDH Zika Factsheet7.94.12017
    7.4.3Communicative Diseases Factsheet7.952011
    7.4.4General Child Seat Use & MD Child Safety Seat Law7.962013
    7.4.5My Plate7.972015
    7.4.6National Safe Kids Campaign Materials-Bike7.982013
    7.4.7National Safe Kids Campaign Materials-Fire7.992013
    7.4.8National Safe Kids Campaign Materials-Gun7.9912013
    7.4.9National Safe Kids Campaign Materials-Poison7.9922014
    7.4.10National Safe Kids Campaign Materials-Water7.9932013
    7.4.11CDC Tuberculosis Training Materials Order Form7.9942015
    7.4.12Center for Immunization Health Education Materials Order Form7.9952014
    7.4.13DHMH Office of Oral Health Printed Materials Request Form7.9962015
    7.4.14HIV/AIDS Prevention Materials Order Form7.9972015
    7.4.15Kids in Safety Seats Education Materials Order Form7.9982013
    7.4.16Lead Poisoning Prevention Program Educational Materials Order Form7.9992008
    7.4.17Maternal & Child Health Bureau Publication Order Form7.99912013
    Section 8TELEPHONE DIRECTORIES8.002016
    AHealthy Kids Consultants8.22017
    BLocal Departments of Social Services8.32014
    CLocal Domestic Violence Directory8.42014
    DLocal Health Departments Administrative Care Coordination Units8.52019
    ELocal Health Departments Children's Health Program (MCHP)8.62015
    FLocal Health Departments Nursing Lead Contacts8.72014
    GLocal Health Departments TB Control Coordinators8.82014
    HLocal Protective Services8.92014
    IMaryland Head Start8.912015
    JMaryland Health Connection Connector Entities8.922014
    KMaryland Local WIC Agencies8.932014
    LMaryland VFC Contact Center8.942015
    MMedicaid Administration & Billing Contacts8.952015
    NMedicaid HealthChoice Managed Care Organization Resource List8.962015
    OMedicaid HealthChoice Managed Care Organization Pharmacy Benefit Managers8.972014
    1 - 150Next