WELL VISIT

HIV (exposure, age 15-65 x 1+, pregnant, Man Sex with Man HIV+ partner, IV drug use, or transactional/commercial sex, inconsistent condom use when not in a mutually monogamous relationship, every 3-6 mo)

..Pre-Exposure Prophylaxis (PrEP): Man Sex with Man, HIV+ partner, inconsistent condom use, syphilis/gonorrhea/chlamydia within 6 mo)

PrEP reduces relative risk by 54% (73% if compliance is >=70%) so it is still important to limit partners, verify status, and use condom

On-Demand PrEP 2-1-1 (an option if not using IV drugs), take 2 pills 2-24 hours before sex then 1 pill 24 hours later then again 1 pill after 24 hours later

Hepatitis B (exposure, born Asia/Africa, IV Drug Abuse, Men having Sex with Men, pregnant)

Syphilis (exposure, Man Sex with Man, prostitute, HIV+ living partner)

Hepatitis C (age 18-79 x 1+, exposure, born 1945-65, transfuse/transplant, IV Drug Abuse, liver disease)

Chlamydia + Gonorrhea (exposure, female sexually active age <=24 or age 25+ with new/multiple partner(s), symptoms)

Latent Tuberculosis (former resident in country at risk, homeless, prison)

Immunizations (may obtain at pharmacy)

..Pediatric

..Adult

COVID

flu (annual) (LIVE VERSION CONTRAINDICATED: PREGNANT, IMMUNOCOMPROMISED, or CLOSE CONTACT TO IMMUNOCOMPROMISED), inactive version recommended for pregnant, immunocompromised, or close contact with immunocompromised)

TDaP tetanus Diphtheria Pertussis (every 10 years, each pregnancy week 27-36)

MMR Measles Mumps Rubella (born after 1957, advanced education) (CONTRAINDICATED: PREGNANT or IMMUNOCOMPROMISED)

VAR x 2 Varicella (no history of vaccination or disease) (CONTRAINDICATED: PREGNANT or IMMUNOCOMPROMISED) USA vaccination began 1995

HepB x 3 Hepatitis B (age<=60) USA vaccination began 1982; new increased age

HPV Human Papilloma Virus (age 11-26) USA vaccination began 2006; +/- age 27-45

PCV15 or PCV20 pneumococcal (age >=age65 and no history of any pneumococcal vaccination) USA vaccination began for adults in 1977 and pediatrics 2000; new type

RZV x 2 Recombinant Zoster Vaccine shingles (age 50+, immunocompromised) new

RSV Respiratory Syncytial Virus (pregnant gestation week 32-26 and Sep-Jan) +/- age 60+ new

..Additional Immunizations for Specific Populations

Pregnant: (1 TDaP each pregnancy week 27-36, RSV gestation week 32-36 Sep-Jan) (CONTRAINDICATED: LIVE VERSION FLU, MMR, Var, HPV)

Immunocompromised: RZV, pneumococcal (CONTRAINDICATED: LIVE VERSION FLU, MMR, Var)

Chronic Liver Disease: hepA

Healthcare Personnel: shingles RZV

Men who have Sex with Men : shingles RZV, HPV <=age26, monkeypox if exposure https://myturn.ca.gov/

CANCER

Breast Cancer

..mammogram: (women age 50-74 biennial will soon change to 40-74 biennial) option age 40+ every 1-2 years (annual preferred)

all mammograms ordered are 2D mammogram with 3D tomosynthesis

if silicone implants, in addition to mammogram with additional views also post-operatively MRI or ultrasound at 5-6 years then every 2-3 years (implant rupture risk during mammography is 1%)

..BRCA gene (also for Ovarian Cancer)

known family BRCA mutation

Ashkenazi Jewish woman: breast or ovarian cancer in 1st degree relative or two 2nd degree relatives

1st degree * relative(s) with breast cancer:

2 relatives

1 relative with bilateral breast cancer

1st or 2nd degree * relatives

3 relatives with breast cancer

comorbid breast and ovarian cancers

2 relatives with ovarian cancer

male family member with breast cancer

personal history of breast/ovarian cancer

* 1st Degree = parent, sibling, child; 2nd Degree = grandparent, aunt, uncle, half sibling, grandchild, niece, nephew

..endocrine Rx new including for:

age 65+: with 1 first-degree relative with breast cancer

age 45+: with more than 1 first-degree relative with breast cancer or 1 first-degree relative who developed breast cancer before age 50

age 40+: with a first-degree relative with bilateral breast cancer

presence of atypical ductal or lobular hyperplasia or lobular carcinoma in situ on a prior biopsy

..breast exam: +/- self monthly, doctor annually (both preferred)

inform doctor if pain, lump, skin changes, nipple discharge

Cervical Cancer (women age 21-65 every 3 years; every 5 yrs age 30-65 if Pap and HPV normal)

please reschedule if menstruating and ideally abstain from sex 48 hours prior to pap

Colon Cancer (age 45-75), new decreased age +/- age 76-85

..Options

high-sensitivity guaiac fecal occult blood test (HSgFOBT) or FIT fecal immunochemical test annually

stool DNA-FIT (ColoGuard) every 3 years

(help: 844.870.8870, complete UPS drop off or pick up within 24 hours)

virtual colonoscopy (computed tomography colonography) every 5 years

flexible sigmoidoscopy every 5 years

flexible sigmoidoscopy every 10 years + annual FIT

colonoscopy screening every 10 years (preferred) highest detection, risk of perforation is 1%

Lung Cancer (age 50-80 + 20 pack yrs + smoker <=15 yrs) new decreased age

Prostate Cancer men exam/lab +/- annual age 35+

inform doctor if urinating >= 2 times per night, trouble emptying bladder, blood in urine/semen, weight loss, erectile dysfunction

ABUSE

Intimate Partner Violence (childbearing age female)

ENDOCRINOLOGY

Diabetes (age 35-70 overweight/obese, Family History, ethnicity: African, Native, Asian, Hispanic, Pacific Islanders)

Osteoporosis (age 65+ female)

DERMATOLOGY

Skin Cancer (if fair skinned) shade 10AM-4PM, cover, SPF 30+

inform doctor if any suspicious lesions including using ABCDE pneumonic:

Asymmetry, Border irregular, Color black or varying, Diameter >5mm, Evolving/Enlargement/Elevation

PREGNANCY PLANNING

folic acid 400-800ug daily

MORE INFORMATION

Guideline Clearinghouse

Prevention and Wellness

Annual Wellness Visits are recommended. In the US, wellness visits and preventive health screenings have not returned to pre-pandemic levels. ~ JAMA We have always remained open for In Person visits

and since the start of the pandemic we added Telehealth (portal, telephone, video) visits.