TNAAP's EPSDT Age Specific Encounter Forms 

TNAAP has age-specific chart documentation forms to assist practitioners in documenting EPSDT/TENNderCare services. 

Pediatricians developed these forms with input from staff, MCOs, and TennCare representatives.  Use of these one-page forms help track the various age-specific requirements and prompt appropriate documentation of each service provided. 

 

The TNAAP EPSDT chart documents were updated in July 2006 and now reflect recent changes in immunization recommendations including:

  • New Rotavirus vaccine for 2, 4, and 6 months
  • Hepatitis A starting at 12 months 
  • Human Papilloma Virus vaccine for adolescent girls
  • Meningococcal vaccine for adolescents
  • Tdap for adolescents
  • 2nd dose of varicella vaccine which has been approved by the ACIP and will most likely be added soon

 To download pdf's of the forms click on each link below:

Many of our Forms and Documents on this website are in .pdf file format, you will need Adobe Acrobat Reader to download most of them. 

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Newborn

One Month Visit

Two Month Visit

Four Month Visit

Six Month Visit

Nine Month Visit

12 Month Visit

15 Month Visit

18 Month Visit

2 Year Visit

3 Year Visit

4 Year Visit

5 Year Visit

6 to 10 Year Visit

11 to 14 Year Visit

15 to 20 Year Visit