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DHS Program Resources Child and Teen Checkups Coordinators

Child and Teen Checkups (C&TC) Program

Information for Coordinators

C&TC Documentation Forms for Providers and Clinics

0-1 month visit (DHS-4813A)

2 month visit (DHS-4813B)

4 month visit (DHS-4813C)

6 month visit (DHS-4813D)

9 month visit (DHS-4813E)

12 month visit (DHS-4813F)

15 month visit (DHS-4813G)

18 month visit (DHS-4813H)

24 month visit (DHS-4813I)

30 month visit (DHS-4813J)

3 year visit (DHS-4813K)

4 year visit (DHS-4813L)

5 year visit (DHS-4813M)

6 year visit (DHS-4813N)

7 year visit (DHS-4813O)

8 year visit (DHS-4813P)

9 year visit (DHS-4813Q)

10 year visit (DHS-4813R)

11 year visit (DHS-4813S)

12 year visit (DHS-4813T)

13-14 year visit (DHS-4813U)

15 year visit (DHS-4813V)

16 year visit (DHS-4813W)

17 year visit (DHS-4813X)

18 year visit (DHS-4813Y)

19-20 year visit (DHS-4813Z)

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