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How to properly document wellness visits and physicals

Answers to billing and coding questions submitted by readers

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Medicare Wellness Visits Back to MLN Print November 2023 Updates

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What’s Changed?

  • Added information about monthly chronic pain management and treatment services
  • Added information about checking for cognitive impairment during annual wellness visits
  • Added information about Social Determinants of Health Risk Assessments as an optional element of annual wellness visits

hpi for well visit

Quick Start

The Annual Wellness Visits video helps you understand these exams, as well as their purpose and claim submission requirements.

Medicare Physical Exam Coverage

Initial Preventive Physical Exam (IPPE)

Review of medical and social health history and preventive services education.

✔ New Medicare patients within 12 months of starting Part B coverage

✔ Patients pay nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)

Visit to develop or update a personalized prevention plan and perform a health risk assessment.

✔ Covered once every 12 months

Routine Physical Exam

Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.

✘ Medicare doesn’t cover a routine physical

✘ Patients pay 100% out-of-pocket

Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health :

  • Health Equity Technical Assistance Program
  • Disparities Impact Statement

Communication Avoids Confusion

As a health care provider, you may recommend that patients get services more often than we cover or that we don’t cover. If this happens, help patients understand they may have to pay some or all costs. Communication is key to ensuring patients understand why you’re recommending certain services and whether we cover them.

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Initial Preventive Physical Exam

The initial preventive physical exam (IPPE), also known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it’s provided within the first 12 months after the patient’s Part B coverage starts.

1. Review the patient’s medical and social history

At a minimum, collect this information:

  • Past medical and surgical history (illnesses, hospital stays, operations, allergies, injuries, and treatments)
  • Current medications, supplements, and other substances the person may be using
  • Family history (review the patient’s family and medical events, including hereditary conditions that place them at increased risk)
  • Physical activities
  • Social activities and engagement
  • Alcohol, tobacco, and illegal drug use history

Learn information about Medicare’s substance use disorder (SUD) services coverage .

2. Review the patient’s potential depression risk factors

Depression risk factors include:

  • Current or past experiences with depression
  • Other mood disorders

Select from various standardized screening tools designed for this purpose and recognized by national professional medical organizations. APA’s Depression Assessment Instruments has more information.

3. Review the patient’s functional ability and safety level

Use direct patient observation, appropriate screening questions, or standardized questionnaires recognized by national professional medical organizations to review, at a minimum, the patient’s:

  • Ability to perform activities of daily living (ADLs)
  • Hearing impairment
  • Home and community safety, including driving when appropriate

Medicare offers cognitive assessment and care plan services for patients who show signs of impairment.

  • Height, weight, body mass index (BMI) (or waist circumference, if appropriate), blood pressure, balance, and gait
  • Visual acuity screen
  • Other factors deemed appropriate based on medical and social history and current clinical standards

5. End-of-life planning, upon patient agreement

End-of-life planning is verbal or written information you (their physician or practitioner) can offer the patient about:

  • Their ability to prepare an advance directive in case an injury or illness prevents them from making their own health care decisions
  • If you agree to follow their advance directive
  • This includes psychiatric advance directives

6. Review current opioid prescriptions

For a patient with a current opioid prescription:

  • Review any potential opioid use disorder (OUD) risk factors
  • Evaluate their pain severity and current treatment plan
  • Provide information about non-opiod treatment options
  • Refer to a specialist, as appropriate

The HHS Pain Management Best Practices Inter-Agency Task Force Report has more information. Medicare now covers monthly chronic pain management and treatment services .

7. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them to treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

8. Educate, counsel, and refer based on previous components

Based on the results of the review and evaluation services from the previous components, provide the patient with appropriate education, counseling, and referrals.

9. Educate, counsel, and refer for other preventive services

Include a brief written plan, like a checklist, for the patient to get:

  • A once-in-a-lifetime screening electrocardiogram (ECG), as appropriate
  • Appropriate screenings and other covered preventive services

Use these HCPCS codes to file IPPE and ECG screening claims:

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv

* Section 60.2 of the Medicare Claims Processing Manual, Chapter 9 has more information on how to bill HCPCS code G0468.

Report a diagnosis code when submitting IPPE claims. We don’t require you to use a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an IPPE when performed by a:

  • Physician (doctor of medicine or osteopathy)
  • Qualified non-physician practitioner (physician assistant, nurse practitioner, or certified clinical nurse specialist)

When you provide an IPPE and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

CPT only copyright 2022 American Medical Association. All rights reserved.

IPPE Resources

  • 42 CFR 410.16
  • Section 30.6.1.1 of the Medicare Claims Processing Manual, Chapter 12
  • Section 80 of the Medicare Claims Processing Manual, Chapter 18
  • U.S. Preventive Services Task Force Recommendations

No. The IPPE isn’t a routine physical that some patients may get periodically from their physician or other qualified non-physician practitioner (NPP). The IPPE is an introduction to Medicare and covered benefits, and it focuses on health promotion, disease prevention, and detection to help patients stay well. We encourage providers to inform patients about the AWV during their IPPE. The Social Security Act explicitly prohibits Medicare coverage of routine physical exams.

No. The IPPE and AWV don’t include clinical lab tests, but you may make appropriate referrals for these tests as part of the IPPE or AWV.

No. We waive the coinsurance, copayment, and Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening electrocardiogram (ECG) (HCPCS codes G0403, G0404, or G0405).

A patient who hasn’t had an IPPE and whose Part B enrollment began in 2023 can get an IPPE in 2024 if it’s within 12 months of the patient’s Part B enrollment effective date.

We suggest providers check with their MAC for available options to verify patient eligibility. If you have questions, find your MAC’s website .

Annual Wellness Visit Health Risk Assessment

The annual wellness visit (AWV) includes a health risk assessment (HRA). View the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments has more information, including a sample HRA.

Perform an HRA

  • You or the patient can update the HRA before or during the AWV
  • Consider the best way to communicate with underserved populations, people who speak different languages, people with varying health literacy, and people with disabilities
  • Demographic data
  • Health status self-assessment
  • Psychosocial risks, including, but not limited to, depression, life satisfaction, stress, anger, loneliness or social isolation, pain, suicidality, and fatigue
  • Behavioral risks, including, but not limited to, tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (for example, seat belt use), and home safety
  • Activities of daily living (ADLs), including dressing, feeding, toileting, and grooming; physical ambulation, including balance or fall risks and bathing; and instrumental ADLs (IADLs), including using the phone, housekeeping, laundry, transportation, shopping, managing medications, and handling finances

1. Establish the patient’s medical and family history

At a minimum, document:

  • Medical events of the patient’s parents, siblings, and children, including hereditary conditions that place them at increased risk
  • Use of, or exposure to, medications, supplements, and other substances the person may be using

2. Establish a current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including behavioral health care.

  • Height, weight, body mass index (BMI) (or waist circumference, if appropriate), and blood pressure
  • Other routine measurements deemed appropriate based on medical and family history

4. Detect any cognitive impairments the patient may have

Check for cognitive impairment as part of the first AWV.

Assess cognitive function by direct observation or reported observations from the patient, family, friends, caregivers, and others. Consider using brief cognitive tests, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Alzheimer’s and Related Dementia Resources for Professionals has more information.

5. Review the patient’s potential depression risk factors

6. Review the patient’s functional ability and level of safety

  • Ability to perform ADLs

7. Establish an appropriate patient written screening schedule

Base the written screening schedule on the:

  • Checklist for the next 5–10 years
  • United States Preventive Services Task Force and Advisory Committee on Immunization Practices (ACIP) recommendations
  • Patient’s HRA, health status and screening history, and age-appropriate preventive services we cover

8. Establish the patient’s list of risk factors and conditions

  • A recommendation for primary, secondary, or tertiary interventions or report whether they’re underway
  • Mental health conditions, including depression, substance use disorders , suicidality, and cognitive impairments
  • IPPE risk factors or identified conditions
  • Treatment options and associated risks and benefits

9. Provide personalized patient health advice and appropriate referrals to health education or preventive counseling services or programs

Include referrals to educational and counseling services or programs aimed at:

  • Fall prevention
  • Physical activity
  • Tobacco-use cessation
  • Social engagement
  • Weight loss

10. Provide advance care planning (ACP) services at the patient’s discretion

ACP is a discussion between you and the patient about:

  • Preparing an advance directive in case an injury or illness prevents them from making their own health care decisions
  • Future care decisions they might need or want to make
  • How they can let others know about their care preferences
  • Caregiver identification
  • Advance directive elements, which may involve completing standard forms

Advance directive is a general term that refers to various documents, like a living will, instruction directive, health care proxy, psychiatric advance directive, or health care power of attorney. It’s a document that appoints an agent or records a person’s wishes about their medical treatment at a future time when the individual can’t communicate for themselves. The Advance Care Planning fact sheet has more information.

We don’t limit how many times the patient can revisit the ACP during the year, but cost sharing applies outside the AWV.

11. Review current opioid prescriptions

  • Review any potential OUD risk factors
  • Provide information about non-opioid treatment options

12. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them for treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

13. Social Determinants of Health (SDOH) Risk Assessment

Starting in 2024, Medicare includes an optional SDOH Risk Assessment as part of the AWV. This assessment must follow standardized, evidence-based practices and ensure communication aligns with the patient’s educational, developmental, and health literacy level, as well as being culturally and linguistically appropriate.

1. Review and update the HRA

2. Update the patient’s medical and family history

At a minimum, document updates to:

3. Update current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including those added because of the first AWV personalized prevention plan services (PPPS), and any behavioral health providers.

  • Weight (or waist circumference, if appropriate) and blood pressure

5. Detect any cognitive impairments patients may have

Check for cognitive impairment as part of the subsequent AWV.

6. Update the patient’s written screening schedule

Base written screening schedule on the:

7. Update the patient’s list of risk factors and conditions

  • Mental health conditions, including depression, substance use disorders , and cognitive impairments
  • Risk factors or identified conditions

8. As necessary, provide and update patient PPPS, including personalized health advice and appropriate referrals to health education or preventive counseling services or programs

9. Provide advance care planning (ACP) services at the patient’s discretion

10. Review current opioid prescriptions

11. Screen for potential substance use disorders (SUDs)

12. Social Determinants of Health (SDOH) Risk Assessment

Preparing Eligible Patients for their AWV

Help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:

  • Medical records, including immunization records
  • Detailed family health history
  • Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
  • Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists

Use these HCPCS codes to file AWV claims:

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Report a diagnosis code when submitting AWV claims. We don’t require you to use a specific AWV diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an AWV if performed by a:

  • Medical professional (including health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals directly supervised by a physician

When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs. Don’t bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. We deny these claims with messages indicating the patient reached the benefit maximum for the time period.

Medicare telehealth includes HCPCS codes G0438 and G0439.

ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a patient to discuss their health care wishes and medical treatment preferences if they become unable to communicate or make decisions about their care. At the patient’s discretion, you can provide the ACP during the AWV.

Use these CPT codes to file ACP claims as an optional AWV element:

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Report a diagnosis code when submitting an ACP claim as an optional AWV element. We don’t require you to use a specific ACP diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

We waive both the Part B ACP coinsurance and deductible when it’s:

  • Provided on the same day as the covered AWV
  • Provided by the same provider as the covered AWV
  • Billed with modifier 33 (Preventive Service)
  • Billed on the same claim as the AWV

We waive the ACP deductible and coinsurance once per year when billed with the AWV. If we deny the AWV billed with ACP for exceeding the once-per-year limit, we’ll apply the ACP deductible and coinsurance .

We apply the deductible and coinsurance when you deliver the ACP outside the covered AWV. There are no limits on the number of times you can report ACP for a certain patient in a certain period. When billing this service multiple times, document changes in the patient’s health status or wishes about their end-of-life care.

SDOH is important in assessing patient histories; in assessing patient risk; and in guiding medical decision making, prevention, diagnosis, care, and treatment. In the CY 2024 Medicare Physician Fee Schedule final rule , we added a new SDOH Risk Assessment as an optional, additional element of the AWV. At both yours and the patient’s discretion, you may conduct the SDOH Risk Assessment during the AWV.

Use this HCPCS code to file SDOH Risk Assessment claims as an optional AWV element:

Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes

Report a diagnosis code when submitting an SDOH Risk Assessment claim as an optional AWV element. We don’t require you to use a specific SDOH Risk Assessment diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

The implementation date for SDOH Risk Assessment claims is July 1, 2024. We waive both the Part B SDOH Risk Assessment coinsurance and deductible when it’s:

We waive the SDOH Risk Assessment deductible and coinsurance once per year when billed with the AWV.

If we deny the AWV billed with SDOH Risk Assessment for exceeding the once-per-year limit, we’ll apply the deductible and coinsurance. We also apply the deductible and coinsurance when you deliver the SDOH Risk Assessment outside the covered AWV.

AWV Resources

  • 42 CFR 410.15
  • Section 140 of the Medicare Claims Processing Manual, Chapter 18

No. The AWV isn’t a routine physical some patients may get periodically from their physician or other qualified NPP. We don’t cover routine physical exams.

No. We waive the coinsurance, copayment, and Part B deductible for the AWV.

We cover an AWV for all patients who’ve had Medicare coverage for longer than 12 months after their first Part B eligibility date and who didn’t have an IPPE or AWV within those past 12 months. We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient’s last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.

Generally, you may provide other medically necessary services on the same date as an AWV. The deductible and coinsurance or copayment applies for these other medically necessary and reasonable services.

You have different options for accessing AWV eligibility information depending on where you practice. Check eligibility to find when a patient is eligible for their next preventive service. Find your MAC’s website if you have specific patient eligibility questions.

Know the Differences

An IPPE is a review of a patient’s medical and social health history and includes education about other preventive services .

  • We cover 1 IPPE per lifetime for patients within the first 12 months after their Part B benefits eligibility date
  • We pay IPPE costs if the provider accepts assignment

An AWV is a review of a patient’s personalized prevention plan of services and includes a health risk assessment.

  • We cover an annual AWV for patients who aren’t within the first 12 months after their Part B benefits eligibility date
  • We cover an annual AWV 12 months after the last AWV’s (or IPPE’s) date of service
  • We pay AWV costs if the provider accepts assignment

A routine physical is an exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.

  • We don’t cover routine physical exams, but the IPPE, AWV, or other Medicare benefits cover some routine physical elements
  • Patients pay 100% out of pocket

View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure .

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Time of Care

Well Child Check Visit Notes

Table of Contents

NEWBORN WT/COLOR CHECK

-Healthy _-month old toddler

ADOLESCENT (12 yrs and older)

  • Well Child Check
  • Well Adult Exam
  • DERMATOLOGY
  • Forms & Charts
  • History Templates
  • PE Templates
  • Quick Physical Exam
  • A good Assessment & Plan
  • DIFFERENTIAL DIAGNOSIS
  • Clinic Quick Reference
  • Hospital Quick Reference
  • InfoGraphics
  • Book Chapter in Time of Care
  • Coding Guide
  • Office Management

Yearly "Wellness" visits

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

Your costs in Original Medicare

You pay nothing for this visit if your doctor or other health care provider accepts assignment .

The Part B deductible  doesn’t apply. 

However, you may have to pay coinsurance , and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Your doctor or other health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

  • Routine measurements (like height, weight, and blood pressure).
  • A review of your medical and family history.
  • A review of your current prescriptions.
  • Personalized health advice.
  • Advance care planning .

Your doctor or other health care provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your doctor or other health care provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.

If you have a current prescription for opioids, your doctor or other health care provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your doctor or other health care provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use , and refer you for treatment, if needed. 

Related resources

  • Preventive visits

Is my test, item, or service covered?

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Well-Woman Chart

Recommendations for well-woman care.

Preventive care visits provide an excellent opportunity for well-woman care including screening, evaluation of health risks and needs, counseling, and immunizations. Recommendations for Well-Woman Care – A Well-Woman Chart was developed by the Women’s Preventive Services Initiative (WPSI). The Well-Woman Chart outlines preventive services recommended by the WPSI, U.S. Preventive Services Task Force (USPSTF), and Bright Futures based on age, health status, and risk factors. Additional recommendations for immunizations are provided in a separate table from the Advisory Committee on Immunization Practices. Clinical practice considerations, risk assessment methods, and the age and frequency to deliver services are described in the Clinical Summary Tables that accompany the chart.

The Recommendations for Well-Woman Care – A Well-Woman Chart provides a framework for incorporating preventive health services for women into clinical practice. These services may be completed at a single visit or as part of a series of visits that take place over time. Recommendations from the WPSI and the USPSTF for preventive services for pregnant and postpartum women are also provided in the Well-Woman Chart. Comprehensive recommendations for pregnant and postpartum women can be found in ACOG’s practice guidelines and other educational materials. The recommendations are not intended as a statement of the standard of care and do not comprise all proper treatments or methods of care. Providers should use clinical judgment in applying these recommendations to individual patient care, taking into account the needs and resources particular to the locality, the institution, or the type of practice. The Chart is updated annually.

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In addition to the printable PDF file, an interactive Well-Woman Chart can be accessed below.

Interactive Well-Woman Chart

Prevention services, general health.

  • Download Full Chart
  • Printable PDF file - Download Here

INFECTIOUS DISEASES

Prevention services for pregnancy and postpartum provided in addition to age-based services listed above.

Recommended by the USPSTF (A or B rating), WPSI, or Bright Futures

Recommended for selected groups

1 Additional Bright Futures recommendations include: Periodic vision and hearing tests ages 13 to 21; screening for suicide risk ages 13 to 21; risk assessment for sudden cardiac arrest and sudden cardiac death ages 13 to 21; risk assessment for anemia ages 13 to 21; and fluoride supplementation if needed ages 13 to 16.

Abbreviations:

  • BRCA = breast cancer susceptibility gene;
  • CVD = cardiovascular disease;
  • HIV = human immunodeficiency virus;
  • HCV = hepatitis C virus;
  • HBV = hepatitis B virus;
  • STI = sexually transmitted infection;
  • USPSTF = U.S. Preventive Services Task Force;
  • WPSI = Women’s Preventive Services Initiative.

*Criteria for Selective Screening Diabetes screening and management: Screen women with overweight or obese BMI ages 35 to 70 years; and women with previous gestational diabetes but not previously diagnosed with type 2 diabetes when not pregnant ages ≥13 years. Folic acid supplementation: Sexually active and planning or capable of pregnancy. Healthy diet and physical activity counseling: Overweight or obese BMI and additional CVD risk factors (hypertension, dyslipidemia, abnormal blood glucose levels, diabetes). Lipid screening: Familial dyslipidemia, risk factors, or high-risk conditions ages 13 to 17 years. Osteoporosis screening: 10-year fracture risk equivalent to an average-risk 65-year-old woman based on specific risk factors (parental history of hip fracture, smoking, white race, excess alcohol consumption, low body weight). Statin use to prevent CVD: Ages 40 to 75 years, one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking), and calculated 10-year risk of a CVD event ≥10%. Urinary incontinence screening: Screen all women ages ≥18 and younger women if postpartum. Gonorrhea and chlamydia screening: New sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI; inconsistent condom use among persons who are not in mutually monogamous relationships; previous or coexisting STI; and exchanging sex for money or drugs. Prevalence is also higher among incarcerated populations, military recruits, and patients receiving care at public STI clinics. Hepatitis B screening: Born in a country with a prevalence of HBV infection ≥2%; lack of vaccination in infancy in U.S.-born persons with parents from a country or region with prevalence ≥8%; HIV-positive; injection drug use; and household contacts or sexual partners of persons with HBV infection. Hepatitis C screening: One-time screening for asymptomatic adults ages 18 to 79 without known liver disease. Repeat screening and screen at other ages if past or current injection drug use. HIV preexposure prophylaxis (PrEP): Candidates include 1) heterosexually active women with a serodiscordant sex partner (i.e., in a sexual relationship with a partner living with HIV); or inconsistent use of condoms during sex with a partner whose HIV status is unknown and who is at high risk; or an STI with syphilis or gonorrhea within the past 6 months; 2) uses injection drugs and shared use of drug injection equipment; or has risk of sexual acquisition of HIV based on above; 3) engaged in transactional sex, such as for money, drugs, or other. Immunizations should be administered according to the most recent Advisory Committee on Immunization Practices (ACIP) recommendations . Accessed December 19, 2022. Sexually transmitted infection prevention counseling: Risk factors for STIs include having an STI currently or within the past year, not consistently using condoms, having multiple sex partners, or having sex partners within populations with a high prevalence of STIs. Increased STI prevalence rates are found among women seeking STI testing or attending STI clinics; sexual and gender minorities; and among those with HIV, using injection drugs, exchanging sex for money or drugs, or residing in correctional facilities. Syphilis screening: Women with HIV; high prevalence communities or populations; history of incarceration; exchanging sex for money or drugs. Tuberculosis infection: Persons from countries with increased tuberculosis prevalence; living in high-risk congregate settings (e.g., homeless shelters, correctional facilities); exposure to individuals with active tuberculosis, such as health care workers and workers in high-risk congregate settings; immunosuppressed individuals. Breast cancer screening: Decisions about screening are made on an individual basis according to risk and preferences through a shared-decision making process. Lung cancer screening: 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Medications to reduce breast cancer risk: Major risk factors for breast cancer include increasing age, family history of breast or ovarian cancer (especially among first-degree relatives and onset before age 50 years), history of atypical hyperplasia or other nonmalignant high-risk breast lesions, previous breast biopsy, and extremely dense breast tissue. Models suggest that women with an estimated 5-year breast cancer risk of 3% or greater are likely to have more benefit than harm, although the balance of benefits and harms depends on age, race or ethnicity, the medication used, and whether the patient has a uterus. Skin cancer counseling: Fair skin, light hair and eye color, freckles, sunburn easily. Perinatal depression preventive interventions: Counseling interventions for women with one or more of the following: a history of depression, current depressive symptoms that may not reach a diagnostic threshold, socioeconomic risk factors such as low income or adolescent or single parenthood, recent intimate partner violence, or mental health–related factors such as elevated anxiety symptoms or a history of significant negative life events. Diabetes: Universal screening after 24 weeks’ gestation (preferably 24 to 28 weeks); additionally, selective screening for those with risk factors before 24 weeks’ gestation, ideally at the first prenatal visit (obese BMI; increased maternal age; history of gestational diabetes; family history of diabetes; ethnicity with increased risk for type 2 diabetes [Hispanic, Native American, South or East Asian, African American, or Pacific Islands descent]). Preeclampsia prevention with low-dose aspirin: History of preeclampsia, especially when accompanied by an adverse outcome; multifetal gestation; chronic hypertension; type 1 or 2 diabetes; renal disease; autoimmune disease (systemic lupus erythematous, antiphospholipid syndrome). Diabetes screening after pregnancy: Previous gestational diabetes but not previously diagnosed with type 2 diabetes when not pregnant ages ≥13 years. Suggested Citation Women’s Preventive Services Initiative. Recommendations for well-woman care – a well-woman chart.  Washington, DC: ACOG Foundation; 2023. Available at: https://www.womenspreventivehealth.org/wp-content/uploads/FINAL_WPSI_WWC_11x17_2023.pdf . Retrieved March 21, 2023. Women’s Preventive Services Initiative. Recommendations for well-woman care: clinical summary tables.  Washington, DC: ACOG Foundation; 2023. Available at: https://www.womenspreventivehealth.org/wp-content/uploads/FINAL_WPSI_ClinicalSummaryTables_2023.pdf . Retrieved March 22, 2023. Inquiries All inquiries regarding HRSA acceptance and support of the WPSI recommendations should be sent to   [email protected] . Inquiries regarding the content or evidence related to the recommendations can be sent to [email protected] . ©2023, Content owned by the ACOG Foundation, all Marks and Rights Reserved. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UHOMC29940, Bright Futures for Women’s Health: Standard Practice Guidelines for Well Women Care. This information or content and conclusions are those of the author and should not be construed as the official position nor policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. How to Get the Well-Woman Chart Shortcut on Your Smartphone

The Women’s Preventive Services Initiative’s (WPSI)  Recommendations for Well-Woman Care – A Well-Woman  Chart   summarizes preventive service recommendations for women from the WPSI, U.S. Preventive Services Task Force (USPSTF) and Bright Futures. The Well-Woman Chart provides a framework for incorporating preventive health services for women into clinical practice. To increase accessibility of these recommendations, the digitally-interactive version of the Well-Woman Chart can be added as a shortcut to your mobile device. Please note an internet connection is required to access the Well-Woman Chart from the home screen shortcut.

Follow these step-by-step instructions to add the Well-Woman Chart shortcut to the home screen of your mobile device.

Well-Woman Chart Shortcut for iPhone

  • Visit   www.acog.org/WellWomanChart   from your mobile device.
  • Tap the Options icon towards the bottom of the screen.
  • Tap the “Add to Home Screen” star icon.
  • Edit the shortcut name to “WPSI.”
  • See the shortcut appear.

Well-Woman Chart Shortcut for Android

  • Visit www.acog.org/WellWomanChart   from your mobile device.
  • Tap the Menu icon towards the top, right of the screen.
  • Tap the “Add to Home Screen” icon.

Frequently Asked Questions

Recommendations for Well-Woman Care – A Well-Woman Chart is a resource developed by the Women’s Preventive Services Initiative (WPSI) that summarizes age-based preventive service recommendations for women from adolescence into maturity.  Scroll down  for frequently asked questions and answers about the chart.

*For this FAQ, the Women’s Preventive Services Initiative’s (WPSI) Recommendations for Well-Woman Care—a Well-Woman Chart will be referred to as the Well-Woman Chart.

Download the PDF version below.

hpi for well visit

What is a Well-Woman Visit?

A well-woman visit, often referred to as a wellness visit, regular checkup, or periodic health examination, is a clinical encounter that promotes health over the course of a woman’s lifetime through preventive health care 1 . Well-woman preventive services may include, but are not limited to: assessment of physical and psychosocial function, primary and secondary prevention and screening, risk factor assessments, immunizations, counseling, education, prepregnancy care, and many services necessary for prenatal and interpregnancy care 2,3 . “The selection of a health care provider for the well-woman visit will be determined by the woman’s needs and preferences, access to health services, plan, and age category.” 1  A well-woman visit may be conducted over one visit or over numerous encounters 1 .

What is the difference between a well-woman visit and a sick visit?

A well-woman visit focuses on promoting and maintaining health over the course of a woman’s lifetime through preventive health care, and a sick or problem visit focuses on diagnosis and treatment of new or existing symptoms or problems.

What is the goal of the well-woman chart?

The Well-Woman Chart is designed as a tool and a starting point for providing well-woman care and implementing the WPSI-recommended  well-woman preventive visits . The chart should be adapted as necessary to meet a woman’s needs.

Does the well-woman chart only cover WPSI recommendations?

No, the Well-Woman Chart is a compilation of preventive service recommendations for women from the  WPSI , U.S. Preventative Services Taskforce ( USPSTF ), and  Bright Futures .

Is the well-woman chart a stand-alone document?

No, the Well-Woman Chart includes corresponding  clinical summaries  with the appropriate age and frequencies in which the preventive services should be performed, considerations for clinical practice, and any relevant risk assessments.

How is the well-woman chart structured?

The Well-Woman Chart is a summary chart of preventive services recommendations for women from the  WPSI , the  USPSTF , and  Bright Futures . The chart is separated by age group, and services are broken into the categories of general health, infectious diseases, and cancer. These services are also listed in alphabetical order for ease of use. When the recommendations overlap between the various groups, the chart uses the most inclusive recommendation. Recommendations from the WPSI and the USPSTF for preventive services for pregnant and postpartum women are also provided in the Well-Woman Chart.

Who should be using the well-woman chart?

The Well-Woman Chart can be used by any health care provider who is providing preventive well-woman care, including family physicians, internists, ob–gyns, physician assistants, nurse practitioners, and certified nurse–midwives.

How do I access the well-woman chart?

The Well-Woman Chart and its accompanying clinical summaries can be found on the  WPSI website .

My organization's guidelines conflict with the recommendations in the well-woman chart. What do I do?

Please defer to your clinical institutional authority in the event of conflicting guidance.

Do women need a well-woman visit every year?

The  WPSI recommends  that women receive at least one preventive care visit per year beginning in adolescence and continuing across the life span to ensure that the recommended preventive services are obtained.

How do I prioritize well-woman exam services in the time allotted for each woman?

Each woman is unique, as are her health care needs. Decisions regarding when to initiate screening, how often to screen, and when to stop screening should be based on a periodic shared decision-making process involving the woman and her health care provider. The shared decision-making process assists women in making an informed decision and includes, but is not limited to, a discussion about the benefits and harms of screening; an assessment of the woman’s values and preferences; and consideration of factors such as life expectancy, comorbidities, and health status. 2

Do I need to do all these services in one visit?

The services listed in the Well-Woman Chart should not be viewed as what is expected to be performed at every well-woman visit by every health care provider. Additional well-woman visits may be needed to obtain all necessary services depending on a woman’s age, health status, reproductive health needs, pregnancy status, and risk factors.

What about health insurance coverage?

All recommendations listed on the Well-Woman Chart include clinical preventive services that most private insurance plans and many Medicaid state programs cover without cost-sharing as required by the Affordable Care Act. For more information about federal coverage requirements for preventive services, refer to  healthcare.gov  and your insurance carrier.

Do you have any resources to assist with billing?

The American College of Obstetricians and Gynecologists (ACOG) offers  coding resources . You can also submit coding questions to the ACOG coding team through our  Coding Ticket Database . This resource is available to both ACOG members and nonmembers.

What about immunizations?

Immunizations should be administered according to the  most recent ACIP recommendations .

  • Conry, Brown. Well-Woman Task Force: Components of the Well-Woman Visit. Obstetrics & Gynecology 2015; 126: 697-701.  https://journals.lww.com/greenjournal/Fulltext/2015/10000/Well_Woman_Task_Force__Components_of_the.2.aspx
  • Women’s Preventive Services Initiative. Recommendations for preventive services for women: final report to the U.S. Department of Health and Human Services, Health Resources and Services Administration. Washington, D.C.: American College of Obstetricians and Gynecologists; 2016.
  • Well-woman visit. ACOG Committee Opinion No. 755. American College of Obstetricians and Gynecologists. Obstetrics & Gynecology 2018; 132: 181–86.  https://journals.lww.com/greenjournal/Fulltext/2018/10000/ACOG_Committee_Opinion_No__755_Summary__.57.aspx
  • U.S. Department of Health and Human Resources Women’s Preventive Services Guidelines.  https://www.hrsa.gov/womens-guidelines-2016/index.html –  Accessed August 15, 2018.

WPSI Coding Guide

Patient education, social media tool kit, recommendation videos.

hpi for well visit

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JOEL J. HEIDELBAUGH, MD

Am Fam Physician. 2018;98(12):729-737

Patient information : See related handout on adult men's health .

Author disclosure: No relevant financial affiliations.

The adult well-male examination should provide evidence-based guidance toward the promotion of optimal health and well-being. The medical history should focus on tobacco and alcohol use, risk of human immunodeficiency virus and other sexually transmitted infections, and diet and exercise habits. The physical examination should include blood pressure screening, and height and weight measurements to calculate body mass index. Lipid screening is performed in men 40 to 75 years of age; there is insufficient evidence for screening younger men. One-time screening ultrasonography for detection of abdominal aortic aneurysm is recommended in men 65 to 75 years of age who have ever smoked. Screening for prostate cancer using prostate-specific antigen testing in men 55 to 69 years of age should be individualized using shared decision making. Screening for colorectal cancer should begin at 50 years of age for average-risk men and continue until at least 75 years of age. Screening options include fecal immunochemical testing, colonoscopy, or computed tomography colonography. Lung cancer screening using low-dose computed tomography is recommended in men 55 to 80 years of age who have at least a 30-pack-year smoking history and currently smoke or have quit within the past 15 years. Immunizations should be updated according to guidelines from the Advisory Committee on Immunization Practices.

The goals of the adult well-male examination are to provide evidence-based guidance toward the promotion of optimal health and well-being, to screen for and potentially prevent premature morbidity and mortality from chronic diseases, and to provide age-appropriate cancer screening and immunizations. Most primary care guidelines come from the U.S. Preventive Services Task Force (USPSTF) and have been adopted by the American Academy of Family Physicians (AAFP). 1 , 2 Some subspecialty guidelines offer additional guidance but may have conflicting recommendations. Currently, there is no accepted guideline for frequency of adult well-male examinations, although many private health insurance plans and Medicare recommend annual examinations.

WHAT IS NEW ON THIS TOPIC

The life expectancy of U.S. men in 2015 was 76.3 years, a slight decrease from previous averages and five years lower than that of women.

The U.S. Preventive Services Task Force found insufficient evidence to recommend for or against lipid screening in any risk group younger than 40 years.

In 2007, men 15 to 65 years of age were significantly less likely than women to seek preventive care services from a primary care physician (15% vs. 44% of total visits, respectively). 3 In 2000, one in three men reported not having a primary care physician, compared with one in five women. 4 No data are available on the impact of the Patient Protection and Affordable Care Act. The life expectancy of U.S. men in 2015 was 76.3 years, a slight decrease from previous averages and five years lower than that of women. 5 Table 1 includes Centers for Disease Control and Prevention statistics related to men’s health and well-being. 6

For the evaluation of men, the patient history should be comprised of medical and surgical histories, current medications, and allergies. Family history relevant to the risk of chronic diseases and cancer should also be included. Social history should focus on lifestyle risks that contribute to premature morbidity and mortality, including substance use, risk of human immunodeficiency virus and other sexually transmitted infections (STIs), and diet and exercise habits. Evaluation of men with Medicare should also include gait stability, their ability to achieve activities of daily living, and depression screening.

Screening for Lifestyle and Mental Health Risks

Table 2 summarizes screening guidelines for lifestyle and mental health risks in men. 7 – 21

TOBACCO AND SUBSTANCE USE

Men should be asked about tobacco and alcohol use at every visit. 7 , 8 The USPSTF found insufficient evidence to recommend for or against screening for illicit drug use 9 ; however, the National Institute on Drug Abuse recommends screening for nonmedical prescription drug use and other illicit drug use. 10 Clinicians can use recommended counseling approaches such as the five A’s (ask, advise, assess, assist, and arrange), the CAGE questionnaire, or motivational interviewing. 8 , 22

SEXUALLY TRANSMITTED INFECTIONS

Men with risk factors, including men with multiple sex partners, men who engage in unprotected sex, and men who have sex with men, should be screened for STIs. 11 , 12 , 23 There is good evidence of increased yield from routine screening for human immunodeficiency virus infection in persons who report no individual risk factors but are seen in high-risk or high-prevalence clinical settings, including STI clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics serving men who have sex with men, and adolescent health clinics that have a high prevalence of STIs. However, all men should be offered screening. 13

One study concluded that counseling patients about the use of condoms is likely to benefit some patients at STI clinics and minimize the risk of infection transmission, although it is unlikely to benefit men who have sex with men. 24 The cost-effectiveness of implementing behavioral counseling in STI programs is unclear, but feasibility would be improved if behavioral counseling were implemented in the context of other prevention efforts.

Men should be screened for depression using the two-item Patient Health Questionnaire (PHQ; http://www.commonwealthfund.org/usr_doc/PHQ2.pdf ). If results of the PHQ-2 are positive, the patient should be further evaluated using the PHQ-9 ( https://www.phqscreeners.com/sites/g/files/g10049256/f/201412/PHQ-9_English.pdf ). 17

Screening for Chronic Conditions

Table 3 summarizes screening guidelines for chronic conditions in men. 18 , 25 – 40

CARDIOVASCULAR RISK

Components of the adult well-male examination include blood pressure screening and height and weight measurements to calculate body mass index (BMI). 18 , 25

Hypertension . Men should be screened for high blood pressure. 25 When treatment decisions are being made, blood pressure should be considered with global risk of cardiovascular disease (CVD); smoking status; presence of diabetes mellitus, dyslipidemia, or obesity; physical activity level; age; and sex. 25 Hypertension (defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher by the Eighth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [JNC-8]) can be diagnosed after two or more elevated readings are obtained on at least two visits over a period of one to several weeks. 28 Recent guidelines recommend a cutoff for stage 1 hypertension of 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic 41 ; however, the AAFP continues to support the cutoff recommended by the JNC-8. 26 , 42

Evidence supports ambulatory blood pressure monitoring as the reference standard for confirming elevated office blood pressure measurements to avoid misdiagnosis and overtreatment of persons with isolated clinic hypertension (white coat hypertension). 29 The ASCVD (Atherosclerotic Cardiovascular Disease) Risk Estimator (available at http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/ ) can be used to determine the 10-year risk of cardiovascular events or stroke in men 40 to 79 years of age.

Obesity . Height and weight measurements should be obtained at every visit to calculate BMI. 18 An abdominal (waist) circumference greater than 40 inches is associated with an increased risk of type 2 diabetes, dyslipidemia, hypertension, and CVD in men with a BMI of 25 to 35 kg per m 2 . 43 In persons with a BMI of 35 kg per m 2 or greater, determination of waist circumference has limited additional value in the prediction of CVD risk. 43 In Asian and black men, waist circumference and other measures such as waist-to-height ratio may be better indicators of CVD risk than BMI because BMI does not adequately account for differences in visceral fat distribution. 43

Diabetes . Among men 20 years and older, more than 15 million have diabetes and approximately 44.5 million have prediabetes. 44 Diabetes is considered a CVD risk equivalent because diabetes-related comorbidity with other risk factors leads to a higher risk of CVD within 10 years. 31 The American Diabetes Association defines diabetes as an A1C level of 6.5% or higher; fasting plasma glucose concentration of 126 mg per dL (7.0 mmol per L) or greater; plasma glucose concentration of 200 mg per dL (11.1 mmol per L) or greater two hours after a 75-g oral glucose load; and a random plasma glucose concentration of 200 mg per dL or greater in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis (e.g., polyuria, polydipsia, polyphagia). 32

Dyslipidemia . The USPSTF recommends lipid screening in men 40 to 75 years of age; a risk calculator is then used to determine the need for treatment. 33 The optimal interval for screening is uncertain. 33 Notably, the USPSTF found insufficient evidence to recommend for or against screening in any risk group younger than 40 years. 33

Risk factors for CVD include elevated low-density lipoprotein cholesterol, history of CVD or noncoronary atherosclerosis, diabetes, smoking, hypertension, obesity, and family history of CVD before 50 years of age in male relatives or before 60 years of age in female relatives. 33 , 34

Fasting lipoprotein profile is the preferred screening test for dyslipidemia. 33 , 34 For nonfasting samples, total cholesterol and high-density lipoprotein cholesterol measurements are recommended and are sufficient for calculating 10-year cardiovascular risk using most calculators. 45 , 46

Abdominal Aortic Aneurysm . The USPSTF recommends one-time screening ultrasonography for detection of abdominal aortic aneurysm in men 65 to 75 years of age who have ever smoked. 35 Randomized trials show that the benefits of screening and surgical repair in this high-risk group outweigh potential harms. 35 The pooled prevalence of abdominal aortic aneurysm is 4.4%. 47 The mortality rate after dissection and rupture approaches 80% for men who reach the hospital and 50% for men who undergo emergent surgical repair. 48 Smoking is the risk factor most strongly associated with abdominal aortic aneurysm (odds ratio = 5.07) and accounts for 75% of all aneurysms 4 cm or greater. 49 Other risk factors include hypertension, dyslipidemia, family history, and atherosclerosis. A meta-analysis determined that a well-functioning screening program would reduce abdominal aortic aneurysm–related mortality by at least 45%; the number needed to screen to prevent one rupture is 238. 50

OSTEOPOROSIS

The USPSTF found insufficient evidence to recommend for or against screening men for osteoporosis, given that the relative benefits and harms of therapy for osteoporosis in men have not been determined. 36 Although evidence for screening is lacking, men most likely to benefit from screening would have a 10-year risk of osteoporotic fracture equal to or greater than that of a 65-year-old white woman with no additional risk factors. 36 For men, major risk factors include increasing age, white race, and family history. The National Osteoporosis Foundation recommends bone mineral density testing for all men 70 years or older and men 50 to 69 years of age with risk factors (e.g., frailty, low BMI). 37 The USPSTF found insufficient evidence to recommend for or against calcium and vitamin D supplementation to prevent fractures. 51

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The USPSTF recommends against screening adults for chronic obstructive pulmonary disease (COPD) using spirometry. 38 Men with COPD, including those with mild or moderate illness, benefit from smoking cessation and annual influenza vaccination. Moderate evidence suggests that influenza vaccination reduces COPD exacerbations. 38

HEPATITIS C

Screening for hepatitis C should be offered to men at high risk of infection. Adults born between 1945 and 1965 should be offered one-time screening. 39

Cancer Screening

Table 4 summarizes screening guidelines for cancer in men. 52 – 61

TESTICULAR CANCER

The USPSTF recommends against screening asymptomatic men for testicular cancer. Because the incidence of testicular cancer is very low and treatment is often effective even in advanced stages, the benefits of earlier detection are minimal and likely outweighed by the harms of false-positive results and unnecessary workup for benign conditions. 52

SKIN CANCER

The USPSTF concludes that there is insufficient evidence to assess the benefits vs. harms of a whole-body skin examination performed by a primary care clinician for the early detection of skin cancer in men. It concludes that there is also insufficient evidence to assess the benefits vs. harms of counseling patients about performing self-examinations. 53 , 54

PROSTATE CANCER

Screening for prostate cancer in primary care is controversial because it is widely believed that screening has resulted in overdiagnosis and overtreatment of clinically insignificant cancers. An editorial on prostate cancer screening was published in American Family Physician (available at https://www.aafp.org/afp/2018/1015/p478.html ).

Previous USPSTF recommendations argued against screening for prostate cancer with prostate-specific antigen testing because of possible harms, based on data from the European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. 62 Current USPSTF and AAFP guidelines align with American Urological Association guidelines in recommending a discussion of benefits vs. risks of screening for men 55 to 69 years of age and using a shared decision-making approach; screening decisions should be individualized based on risk factors (i.e., family history, black race) and take into account the patient’s values and preferences. 55 , 56 , 63 The USPSTF and AAFP recommend against prostate-specific antigen screening for prostate cancer in men 70 years and older. 55 , 56

Although not recommended by the USPSTF, expert opinion from the American Urological Association and data from an uncontrolled trial suggest that prostate cancer screening should combine the digital rectal examination and prostate-specific antigen test, which improves detection compared with either test alone (positive predictive value = 18% and 45%, respectively). 56 , 64

COLORECTAL CANCER

Screening for colorectal cancer should begin at 50 years of age for average-risk men and continue until at least 75 years of age. 57 Colonoscopy is increasingly becoming the test of choice for colorectal cancer screening in primary care, yet there are no randomized controlled trials comparing colonoscopy, flexible sigmoidoscopy, and fecal occult blood testing (FOBT) with a definable outcome of cancer-specific or all-cause mortality. 57 , 65 , 66 Fecal immunochemical testing has greater sensitivity and specificity compared with guaiac-based FOBT. 67 Fecal DNA testing has not proved more accurate than FOBT or fecal immunochemical testing and has more false-positive results than FOBT (16% vs. 5%). 68 Computed tomography colonography may result in harms from low-dose ionizing radiation exposure or identification of extracolonic findings. 69

LUNG CANCER

Lung cancer is the third most common cancer and the leading cause of preventable cancer-related death in the United States. 70 Smoking is the most important risk factor for lung cancer, accounting for approximately 85% of cases. 71 The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults 55 to 80 years of age who have at least a 30-pack-year smoking history and currently smoke or have quit within the past 15 years, 59 , 72 whereas the AAFP concludes that the evidence is insufficient to recommend for or against screening. 60 Physicians should be aware of the high rate of false-positives with low-dose computed tomography screening; more than one-half of patients require additional testing and tracking, of which only 1.5% receive a lung cancer diagnosis. 73 Screening should be discontinued once a patient has not smoked for 15 years or if a patient develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. 59

Immunizations

The Advisory Committee on Immunization Practices (ACIP) strongly encourages annual influenza vaccination for all adults, with the high-dose preparation recommended for those older than 65 years. ACIP recommends a single tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination, regardless of when the last tetanus and diphtheria toxoids (Td) booster was given. 74

A vaccine series does not need to be restarted, even if a long period has passed between doses, although immunity may need to be verified via serologic testing. 74 Full ACIP vaccine recommendations are available at https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html .

This article updates a previous article on this topic by Heidelbaugh and Tortorello . 75

Data Sources : I performed a bibliographic search of select men’s health topics highlighting USPSTF guidelines, the Cochrane Database of Systematic Reviews, Essential Evidence Plus, the American Urological Association, the Agency for Healthcare Research and Quality, DynaMed, and the National Guideline Clearinghouse database. I searched Medline using the terms men’s health, guidelines, evidence-based, hypertension, hyperlipidemia, obesity, diabetes mellitus, abdominal aortic aneurysm, osteoporosis, prostate cancer, colorectal cancer, lung cancer, testicular cancer, skin cancer, sexually transmitted diseases/infections, and immunizations. Original research studies cited within these guidelines were reviewed. Search dates: September through November 2017.

USPSTF. Published recommendations. http://www.uspreventiveservicestaskforce.org/uspstopics.htm . Accessed September 14, 2017.

AAFP. Clinical recommendations. https://www.aafp.org/online/en/home/clinical/exam.html . Accessed September 14, 2017.

Hsiao CJ, Cherry DK, Beatty PC, Rechtsteiner EA. National ambulatory medical care survey. Natl Health Stat Report. 2010(27):1-32.

Sandman D, Simantov E, An C. Out of touch: American men and the health care system. March 2000. http://www.usrf.org/breakingnews/Men_out_of_touch.pdf . Accessed December 2, 2017.

CDC. Health, United States, 2016. https://www.cdc.gov/nchs/data/hus/hus16.pdf#015 . Accessed August 17, 2018.

CDC. Fast stats. Men's health. https://www.cdc.gov/nchs/fastats/mens-health.htm . Accessed September 15, 2017.

USPSTF. Tobacco smoking cessation in adults, including pregnant women: behavioral and pharmacotherapy interventions. September 2015. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions1 . Accessed September 14, 2017.

USPSTF. Alcohol misuse. May 2013. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/alcohol-misuse-screening-and-behavioral-counseling-interventions-in-primary-care . Accessed September 14, 2017.

USPSTF. Drug use, illicit. January 2008. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/drug-use-illicit-screening . Accessed September 14, 2017.

National Institute on Drug Abuse. Resource guide: screening for drug use in general medical settings. https://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/introduction . Accessed August 17, 2018.

USPSTF. Sexually transmitted infections: behavioral counseling. September 2014. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/sexually-transmitted-infections-behavioral-counseling1 . Accessed September 14, 2017.

USPSTF. Syphilis infection in nonpregnant adults and adolescents: screening. June 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-nonpregnant-adults-and-adolescents . Accessed April 13, 2018.

USPSTF. Human immunodeficiency virus (HIV) infection: screening. April 2013. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening . Accessed September 14, 2017.

AAFP. HIV screening, adolescents and adults. https://www.aafp.org/patient-care/clinical-recommendations/all/hiv-screening.html . Accessed August 17, 2018.

Branson BM, Handsfield HH, Lampe MA, et al.; CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1-17.

DiNenno EA, Prejean J, Irwin K, et al. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017;66(31):830-832.

USPSTF. Depression in adults: screening. January 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/depression-in-adults-screening1 . Accessed September 14, 2017.

USPSTF. Weight loss to prevent obesity-related morbidity and mortality in adults: behavioral interventions. September 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/obesity-in-adults-interventions1 . Accessed October 17, 2018.

USPSTF. Healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors. August 2014. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd . Accessed September 27, 2018.

U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary guidelines for Americans. 2015–2020. Eighth edition. December 2015. https://health.gov/dietaryguidelines/2015/guidelines/ . Accessed November 4, 2017.

U.S. Department of Health and Human Services. Physical activity guidelines. Adults. https://health.gov/paguidelines/guidelines/adults.aspx . Accessed November 4, 2017.

Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252(14):1905-1907.

CDC. STD and HIV screening recommendations. https://www.cdc.gov/std/prevention/screeningreccs.htm . Accessed September 27, 2018.

Brookmeyer KA, Hogben M, Kinsey J. The role of behavioral counseling in sexually transmitted disease prevention program settings. Sex Transm Dis. 2016;43(2 suppl 1):S102-S112.

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USPSTF. Testicular cancer: screening. April 2011. http://www.uspreventiveservicestaskforce.org/uspstf/uspstest.htm . Accessed September 14, 2017.

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Richie JP, Catalona WJ, Ahmann FR, et al. Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination. Urology. 1993;42(4):365-374.

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Young GP, Symonds EL, Allison JE, et al. Advances in fecal occult blood tests: the FIT revolution. Dig Dis Sci. 2015;60(3):609-622.

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Heidelbaugh JJ, Tortorello M. The adult well-male examination [published correction appears in Am Fam Physician . 2012;86(1):8]. Am Fam Physician. 2012;85(10):964-971.

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Nicholas Kristof

What Worries Me About War With China After My Visit to Taiwan

A photograph of a person in military gear aiming his weapon in front of pink smoke.

By Nicholas Kristof

Opinion Columnist, reporting from Taipei, Taiwan

Michael Mullen, the former chairman of the Joint Chiefs of Staff, is concerned enough about the risk of war between the United States and China that he is listening to the audiobook version of Barbara Tuchman’s “The Guns of August,” the classic history of how the major powers in 1914 stumbled into World War I.

“I think this is the most dangerous time since I was a kid in 1962,” during the Cuban missile crisis, he told me. “The world war potential is really, really significant.”

I came to Taiwan to gauge that risk and assess how to manage it better. For what it’s worth, I greatly respect Admiral Mullen — few people know as much about global hot spots and how wars happen — but my best guess is that Americans may be overestimating the risk of conflict, particularly of an all-out invasion of Taiwan by China.

Moreover, I worry that American anxiety about the risk of war with China may inadvertently exacerbate it. “The Guns of August” is, as Mullen noted, a useful prism for reminding us how miscalculation, misunderstanding and escalation created a world war that no one wanted. So we should be alert not only to the risk that China poses to peace in the region but also to the risk we Americans unintentionally pose, and to the possibility that our legitimate efforts to confront China can lead to accidents at sea or air that lead to war.

There is a fine line between deterring China and provoking it. My take is that while we should do significantly more to help Taiwan boost defenses and deter aggression, we should do so quietly, without needlessly humiliating China. Sometimes Americans loudly embrace Taiwan in ways that inflame tensions at times when we should be hoping to lower them.

Let me also make the case that we think too much in terms of an invasion — when the greater risk may be China’s taking lesser nibbles to pressure Taiwan, leading to the possibility of accidents and escalation that could drag us into an unintended world war, as happened in 1914.

It’s disorienting to go from talking to American security experts, deeply worried about war with China, to Taiwan, where most people seem to perceive the risks as lower. Taiwan’s outgoing president, Tsai Ing-wen, said at The New York Times’s DealBook Summit in November that China was probably too overwhelmed with domestic problems to take on an invasion. And the former Taiwan president Ma Ying-jeou, on the other end of the political spectrum, agreed, telling me: “I don’t think China is in any mood to start a war to conquer Taiwan.”

Many prominent people in Taiwan told me that while they appreciate American moral and military support, they also fear that hotheaded, China-bashing Americans don’t understand the region and may make things worse.

“Quite a few Americans, opinion leaders or particular members of Congress, made ridiculous statements over Taiwan,” President Ma told me.

Efforts to help the island sometimes backfire. One example often comes up in conversations in Taiwan: Nancy Pelosi’s high-profile visit to Taiwan in 2022, when she was speaker of the House. It was a gesture of moral support, but it didn’t obviously boost Taiwan’s defenses. And China’s response was to move military ships closer to Taiwan in ways that increase the risk of conflict.

For that reason, 62 percent of Taiwanese said in a poll last year that they thought the Pelosi visit had made Taiwan less secure.

Just as American officials read fiery speeches by Chinese officials and grow alarmed, imagine what Chinese leaders thought when an American Air Force general, Michael Minihan, declared last year that he anticipated war with China soon: “My gut tells me we will fight in 2025.”

Beijing must also have been unnerved when Ely Ratner, a senior Pentagon official, described Taiwan as a strategic asset for the United States. The implication was that America may try to use Taiwan as a military bulwark against China; what such comments and high-level visits like Pelosi’s have in common is that they aggravate the paranoia in Beijing.

Instead, we need to solidify the status quo. That means China doesn’t use military force against Taiwan, and Taiwan isn’t seen as slipping away forever into America’s orbit. Taiwanese officials, including President-elect Lai Ching-te, are prudent enough to say they will maintain that status quo — messy and unsatisfactory though it is — and Washington should as well.

But perhaps the single best way to discourage Xi Jinping from attacking Taiwan is to help Ukraine against Russia. The more the West is united in making Russia pay a stiff price for Vladimir Putin’s invasion, the less inclined Xi will be to take a whack at Taiwan. Yet some Republicans who in theory are hostile to China nonetheless resist funding for Ukraine.

As for President Biden, he has done an excellent job in leading the Western alliance against Putin. But he let himself be intimidated by Putin’s nuclear saber-rattling, especially early in the war, refusing to provide some advanced arms to Ukraine for fear that Putin would respond with tactical nuclear weapons. Xi may thus have absorbed the lesson that nuclear threats work.

Granted, my argument that the risk of war is overblown may be wrong. A rule of thumb in following China is always to distrust people who assert with confidence what will happen. “A China expert is an oxymoron,” Winston Lord, a former ambassador to China, likes to say. In truth, there are legitimate reasons to fear what China might do.

“Xi Jinping has been different from his predecessors in how he talks about Taiwan, in ways that we would be unwise to ignore,” noted Matt Pottinger, a Chinese speaker who was deputy national security adviser under President Donald Trump. Xi has shown greater urgency about “recovering” Taiwan, and has linked this to his own legacy, while matching his talk with a military modernization that targets Taiwan and the United States.

“When I look at the military China is building, it is not a general-purpose military,” said Air Force Secretary Frank Kendall III. “It is designed around the goal of being able to take Taiwan and keep the U.S. out.”

Also ominous: The Times has reported that China appears to have inserted malware into computer networks that operate electrical grids, telecommunications and water supplies that serve United States bases, including those that would respond to an attack on Taiwan.

Yet the basic reason to be skeptical that war is coming is that it’s not in China’s interest or Xi’s (although it’s also true that plenty of nations have started wars that didn’t serve their interests).

An amphibious operation to conquer Taiwan would be an enormous challenge and might well fail. Taiwan is nearly 100 miles from China, without many beaches to offer easy landing. A surprise invasion in Normandy was possible in 1944, but would not be feasible in an age of satellites and drones.

China’s military is inexperienced — the People’s Liberation Army’s last “combat” came when it fired on fellow citizens during the 1989 pro-democracy protests — and deeply corrupt. Well-connected Chinese friends have told me how officers are regularly promoted based on the bribes they pay. Xi is a risk taker, but even he must know that an all-out invasion would be a dangerous roll of the dice.

“Just out of prudence, I think he’s unlikely to do something in the next few years as the alarmists have been promoting in Washington,” said Joseph Nye, a retired Harvard professor with long experience in Pacific strategy.

One step that might make Chinese aggression more likely to succeed — and thus a greater possibility — is a Trump victory in November. Trump has expressed uncertainty about helping Taiwan, and it’s difficult to imagine him coordinating allies to press China to back off.

Alexander C. Huang, a Taiwan strategist, said he took part in a war game set in early 2025 that assumed that Trump was president. The war game was supposed to last three hours, but it was over after two — even before shots were fired — because China and America were making demands that Taiwan couldn’t meet and that were beyond the scope of the game. These included a timetable for unification in China’s case and pressure to spend more on the military from the U.S. War games should always be regarded with some skepticism, and Taiwan did not end here in ashes — but given the possibility of a Trump election, the war game did conclude ominously.

“Taiwan was toast,” Huang said.

In the United States, there are calls to adopt a formal policy of defending Taiwan, replacing the present “strategic ambiguity” of a U.S. response (which Biden has in any case undercut by saying four times that the United States would defend Taiwan).

For the United States to formally say that America would back Taiwan militarily would be a mistake, I believe, partly because of its effect on Taiwan. If Taiwan were confident that the American cavalry would ride to the rescue, it might be less worried about provoking China and do less to defend itself.

The truth is that Taiwan hasn’t been willing to make deep sacrifices for its own security. It’s a wonderful place, partly because it’s much more Athens than Sparta. It allocates a smaller share of G.D.P. to defense than the United States, Israel or Estonia ; it is only now requiring a year of military conscription (for men); and it is phasing out nuclear power plants, which are critical for resilience in a blockade because they provide homegrown power when imports provide 98 percent of energy.

In any case, a tighter squeeze on Taiwan — including a blockade — seems a more likely scenario than a sudden invasion. China could hold high-intensity military exercises that rattle Taiwan. It could cut undersea cables carrying the internet to Taiwan. It could also seize one of the Taiwan-controlled islands, like Taiping.

China broached one alarming idea last year: It announced inspections of ships traveling from Taiwan to the Taiwan-controlled islands of Kinmen and Matsu. It never actually conducted inspections, but the announcement offered a clue to what it may be planning.

What if Xi moved toward a partial blockade of Taiwan, saying: The world recognizes that Taiwan is a part of China, so ships bound for Taiwan are now subject to Chinese customs inspections. The Chinese Coast Guard will board ships periodically, to ensure that papers are in order.

This kind of gradual approach, a salami slicing of Taiwan’s autonomy, is how China neutered Hong Kong.

Maj. Gen. Sun Li-fang of the Taiwan armed forces told me that China is particularly ramping up its efforts to demoralize the Taiwanese people and gain an advantage through what’s called “ cognitive warfare ,” including manipulation of public opinion and the release of fake photos and information. He described it as an update of the strategy for how to win without fighting a battle depicted by the ancient Chinese military strategist Sun Tzu in “The Art of War.”

“The threat is not just coming from guns, artillery, rockets, missiles, warships,” General Sun said. “They’re trying to influence our minds as well.”

What Taiwan needs is more practical help — anti-ship missiles, military training, coordination with allies, better cyberdefenses. Meanwhile, the United States needs to boost the capacity of industry to produce munitions rapidly in a crisis.

The Biden administration has worked very effectively with Japan, South Korea, Australia and the Philippines to prepare for joint action to constrain China. That enhances deterrence. Washington could also do more to help Taiwan cultivate cyberwarfare: If the grid goes out in Taipei, Shanghai should lose power, too. If Taipei’s internet cables are cut, then China’s great firewall should cave so ordinary Chinese are able to read about their leaders’ corruption.

Maybe the best recommendation I heard came from Mark Liu, the chairman of Taiwan Semiconductor Manufacturing Company. He offered this useful advice for Americans aiming to help Taiwan’s security: “Do more. Talk less.”

That advice might have helped the major powers in August 1914 avoid a cataclysmic and unnecessary war. It remains sound counsel today.

Thanks to readers for donating more than $6.3 million so far to the vetted nonprofits in my 2023 holiday giving guide , which has just a few days remaining. That will allow more than 10,000 girls to attend school in sub-Saharan Africa, and help 5,000 young Americans get an education or job training. You can join in the giving at KristofImpact.org until the end of the day on Jan. 31.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow The New York Times Opinion section on Facebook , Instagram , TikTok , X and Threads .

Nicholas Kristof became a columnist for The Times Opinion desk in 2001. He has won two Pulitzer Prizes, for his coverage of China and of the genocide in Darfur. @ NickKristof

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Is Matthew Wong the 21st Century’s van Gogh?

The mfa boston's matthew wong retrospective, “the realm of appearances,” is closing soon and well worth a visit.

Colorful paintings hanging in a museum with white walls

“ The Realm of Appearances ,” the Matthew Wong retrospective currently on view at the Museum of Fine Arts Boston, is full of ghosts. There’s the ghost of Wong himself, of course, who died by suicide in 2019 at age 35. But there are also the ghosts of painters past and present. Wong was an obsessive student of art history, and in his work you find traces of the Fauvists, Qing-era ink painters, Impressionists and Post-Impressionists.

Perhaps no phantom haunts the show as doggedly as that of Vincent van Gogh. This is for biographical reasons as much as aesthetic ones: the list of parallels between the two artists is lengthy, even eerie. Both started painting in their late twenties; both took their own lives in their mid-thirties. Both were outsiders with strong ties to the art world. Both were odd, misfits. Both painted landscapes that were really about people. (The Van Gogh Museum in Amsterdam will be hosting a Wong/van Gogh exhibition later this year.)

Curators at the MFA have made a point to emphasize this connection; beside a van Gogh landscape upstairs (“Ravine”), in a gallery of Post-Impressionist paintings, the museum has added a placard referencing the Wong retrospective. It features a quote from a letter van Gogh wrote to his brother Theo: “When anyone says that such and such [painting] is done too quickly, you can reply that they have looked at it too fast.”

It’s an apt quote to describe Wong’s work, as well as van Gogh’s: like the Dutch master before him, Wong worked at lightning speed, producing over 1,000 paintings and drawings in his seven-year career. (Van Gogh, in his decade of painting, produced about 900 paintings and 1,000 works on paper ). Wong had Tourette’s syndrome and autism and struggled with clinical depression; his mind moved quickly—forward, backward and in circles, around and around.

Wong, who was born in Canada and grew up in both Hong Kong and Toronto, began painting at the age of 27. He already had an MFA in photography from the City University of Hong Kong, which he earned after a failed stint in the world of corporate finance. In 2011, while interning at the Hong Kong pavilion at the Venice Biennale, he had a revelatory encounter with the paintings of Julian Schnabel and Christopher Wool. Soon he had traded his camera for a paintbrush and was devouring art history from the Internet and the local library.

SEE ALSO: Sotheby’s Revamps Its Auction Fees, Reducing Buyer Premiums

The MFA show, which was first exhibited at the Dallas Museum of Art last year, is divided into two main rooms. In the “early” room, you can see Wong’s first attempts at painting. There are ink drawings, small acrylics and large oils. Many of the paintings are clunky and childish: a set of two titled Banishment from the Garden show two muddied faces, possibly those of Adam and Eve. The faces, painted with thick, clumsy lines, are hard to distinguish. In the background of one, Wong carved awkward vertical lines into the paint with a palette knife or the end of a brush.

Two paintings side by side, portraits of a man and a woman with their faces obscured

Wong’s technique may have been unrefined, but plenty of highly skilled painters have nothing to say. Wong had something to say, and it was his vision, his intense desire to express what was within him, that drove him to learn. And learn he did. From his frenzied study of art history, he gleaned lessons in mark making, color and composition. Within three short years of picking up a brush, he was turning out sophisticated and poetic paintings, made up of vibrant colors and quick, obsessive brushstrokes.

Most of these paintings are landscapes, pulled from Wong’s imagination. They’re lonely, sometimes, but also quiet and expansive. In The West , a small ghostly figure, sketched in with white paint, looks out over a dark, mountainous desert. Quick dabs of paint form the land, trees and stars. Around the corner, Blue Rain shows a simple white house surrounded by tall blue trees. A moon hangs above the house, and short streaks of blue rain cross the canvas. The pieces may have been painted quickly, but they reward slow looking.

Wong’s feverish drive didn’t always result in brilliant work. Since his death, the conversation around Wong has dealt in extremes: curators and critics have depicted him as a tormented genius, struck by divine inspiration (Roberta Smith called him “one of the most talented painters of his generation”) . Wong was talented, but he was also still developing. Many of the paintings in the show don’t feel quite done. If the urgency with which Wong painted was a sign of creative inspiration, it was also, sometimes, a sign of compulsion and grasping. Painting was an escape for Wong (he once told a friend that “not painting is pain” ), and artistic glory offered Wong, finally,  the possibility of social acceptance. Sometimes it feels like Wong is running toward something, a beautiful vision, and sometimes it feels like he’s running away from the ghosts at his back.

A landscape painted in a cartoonish and colorful style

But ghosts often go hand-in-hand with beauty, as Wong and van Gogh knew well. Shortly before his death, van Gogh made a painting of a wheat field near Paris. Streaks of rain, depicted as blue lines, cross the field at diagonals; dark crows fly above it. It should be a tragic painting, given how van Gogh died (he shot himself in such a field later that week), but it’s oddly peaceful. The horizon stretches out before you; you can sense, through the streaks of rain, a vastness, an expanse.

Wong’s equivalent painting is Realm of Appearances , from which the show, rightly, takes its title. The piece, completed in 2018, a year before Wong’s death, shows a pink landscape under a moony sky. The land depicted in thick, fast dashes of paint is reminiscent of van Gogh’s brushstrokes but more spacious. There’s a small gray figure in the corner of the scene. You could read the piece as an expression of loneliness. But it’s also serene, transcendent, even. If the figure isn’t at peace, then it’s only because he can’t see the whole picture the way we can. He doesn’t know that he’s surrounded by beauty.

Is Wong our van Gogh? Not quite. Van Gogh was a painter through and through, obsessed with the physical world and with the medium of paint. Wong was more of an image maker, who used paint to provide insight into an unseen, ethereal world. In this sense, he is more Munch or Bonnard than van Gogh. What’s remarkable about Wong, though, is not that he resembled other great painters but rather that he was himself… that in such a short period, he was able to develop his own voice. We’re left to wonder what he might have done, and who he might have been, if he had had more time.

Is Matthew Wong the 21st Century’s van Gogh?

  • SEE ALSO : A Long-Lost Gustav Klimt Portrait Could Fetch $54M at Auction

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Things to do in Moscow: how to visit Moscow | Unmissable, cool & unusual

  • September 2, 2023

Things to do in Moscow best

What are the best things to do in Moscow? What to do in Moscow? First, I will list the main places to visit by theme, passing by the must-sees, but also more unusual places in Moscow. Then, I will describe what to see in Moscow in one day and how to visit Moscow in 2, 3, 4, 5 or 6 days. Let’s go!

Good to know. For more information, click on the places to open the dedicated blog posts.

Main places to visit in Moscow & best things to do in Moscow

I worked in Moscow and I loved this city for its dynamism and energy. We find there from time to time to see friends, remember good memories and enjoy this giant city! Then the time has come for us to share with you our practical guide.

TOP 5 must-see places in Moscow

  • Moscow Red Square
  • St. Basil’s Cathedral
  • Cathedral of Christ the Savior
  • Bolshoi Theatre

Places of cultural, historical and religious interest in Moscow

  • Novodevichy Convent and cemetery
  • Tretyakov Gallery
  • Pushkin Museum of Fine Arts
  • Kremlin Izmaïlovo (pseudo-historic place, recently built in the image of the old, one of the best things to do in Moscow for your Instagram account 😉 )
  • Park and ancient village of Kolomenskoye

Visit Moscow of the Soviet era

  • Moscow State University and Sparrows Hill
  • VDNKh and the Museum of Astronautics, one of the key landmarks of the Soviet era in Moscow
  • GULAG Museum
  • Metro stations
  • The Stalinist skyscrapers, scattered all over the city

Less touristy places in Moscow

  • Gorky Park and the GARAGE museum
  • The old Krasny Oktyabr factory
  • Zaryadye Park
  • Center for Contemporary Art, WINZAVOD
  • Business center, Moscow City

Main districts of Moscow to visit

  • Patriarch Ponds
  • Tchistye Prudy
  • Kuznetsky most
  • Arbat Street

However, regardless of the length of your stay, whether you are going to visit Moscow in 4 days or in 2, you need a visa. The article Obtaining a tourist visa for Russia could then be useful in any case.

What to do and see in Moscow in one day?

List of things to see and do in Moscow in one day:

  • Go to Red Square
  • Visit St. Basil’s Cathedral
  • See Kremlin walls (but not to visit)
  • Visit Cathedral of Christ the Savior
  • Discover Kuznetsky most districts and see Bolshoi Theatre building
  • And if you have time at the end of the day: go to the Sparrows Hill or to the Moscow City for a beautiful view

Things to do in Moscow in 2 days

If you want to visit Moscow in 2 days, there are 2 purposes: do not miss the essential places of Moscow and optimize travel.

  • First day: Red Square , Saint Basil’s Cathedral , Zariadye Park, Bolshoi Theatre , Kremlin
  • Day 2: Cathedral of Christ the Savior, the former Krasny Oktyabr factory on Balchug Island, Gorky Park, Moscow State University (one of the Seven Sisters buildings ) and Sparrow Hill

As 2 days os really short, be sure to choose an accommodation in the best districts where to stay in Moscow .

Walking on Red Square in Moscow: one of the unmissable things to do in Moscow

Iconic place and one of the must-see places in Moscow and even in Russia! Besides, if there was only one place to visit in Moscow in 2 days, this place would then be Red Square, without hesitation. Therefore, starting the city tour with Red Square is ideal . Several buildings are on the square, but not all of them have to be visited. Check out my blog post about Moscow’s Red Square in detail to learn more and not miss anything.

Red Square Moscow

Visiting Saint-Basil’s Cathedral inside

Even more emblematic than Moscow’s Red Square! Built in the middle of the 16th century under the orders of Tsar Ivan Le Terrible, this cathedral is one of the most beautiful monuments of Orthodox art, and definitely one of the unmissable places in Moscow. Visiting Saint-Basil’s Cathedral inside is one of the most beautiful things to do in Moscow!

  • Visit estimate time : 1h30
  • Entry ticket : 700 RUB. Tickets can be purchased on the cathedral’s official website 45 days before the tour.
  • Audio guide (recommended): 500 RUB
  • Opening hours : June to August 10 am-6pm; from November to April: 11 am-5pm; May, September, October 11 am-5pm. Cathedral closed on Wednesdays. Entrance is closed 45 minutes before closing.
  • Find out more in the dedicated article: Saint Basil’s Cathedral in Moscow

Saint Basil's Cathedral

Take a walk in Zariadye park: one of the coolest things to do in Moscow after visiting Red Square

Zaryadie Park is just a 10-minute walk from St. Basil’s Cathedral, so it’s easy to include in your itinerary if you’re going to visit Moscow in 2 days. From its heights, you can see the red walls of the Kremlin. But, the most impressive point of view is the platform which overlooks the Moskva river. A must see! And clearly one of the coolest things to do in Moscow!

  • Open 24 hours a day
  • Good to know! Park Zaryadye is also a place to visit in Moscow in winter. Find out more here: What to do in Moscow in winter?

What to do in Moscow

See the Bolshoi Theatre and discover the Kuznetsky Most district

The Bolshoi Theatre is the most famous Russian theater in the world. The most economical way to see a presentation at the Bolshoi Theater is to take the tickets on the theater’s official website in advance, so here is our tutorial to help you: How to buy entrance tickets to the Bolshoi? In addition, several pedestrian or one-way streets

The Bolshoi Theater is the most famous Russian theater in the world. The most economical way to see a presentation at the Bolshoi Theater is to take the tickets on the theater’s official website in advance, so here is our tutorial to help you: How to buy tickets to the Bolshoi? In addition, several pedestrian or one-way streets are located north of the theater. It is therefore very pleasant to find them to leave the main axes of the megalopolis.

IMG_3040 tickets Bolshoi Theatre dress code

Visit the Moscow Kremlin

Visit Kremlin is on top of things to do in Moscow. A place of power for centuries, the Kremlin then shows us a whole different image when viewed from the inside. If you want to visit Moscow in 2 days, the Kremlin is certainly one of the must-see places in Moscow.

  • Opening hours : Daily from 10 a.m. to 5 p.m., except Thursday.
  • See our blog post about visiting the Moscow Kremlin

Moscow Kremlin: skip-the-line tickets and 8 things not to miss

Visit the Cathedral of Christ the Savior

This impressive Moscow Cathedral is the seat of the Russian Orthodox Church. It is a must see if you visit Moscow in 2 days and clearly one of the things to do in Moscow. The Cathedral of Christ the Savior was first built in 1883 in memory of Russia’s victory over Napoleon’s Grand Army. Then in 1931 Stalin ordered its destruction. It was then rebuilt again (identically) only in 2000.

  • Where? Ulitsa Volkhonka 15. At the foot of the Kropotkinskaya metro station.
  • Opening hours . Daily: 10: 00-17: 00, except Monday: 13: 00-17: 00
  • Free entry (some closing restrictions, for example a short)

Good to know! In orthodox religious places, one must avoid excessively uncovered clothing. Women should cover their heads. After visiting the Cathedral of Christ the Savior, you can explore Bolotny Island and Gorky Park. This is one of the routes our guide to Moscow.

Cathedral of Christ the Savior

The old Krasny Oktyabr factory: one of the coolest things to do in Moscow

If you cross the Moskva River by a pedestrian bridge which is located just in front of the Cathedral of Christ the Savior, you will enjoy a beautiful view of the city and at the same time you can discover Balchug Island. Furthermore, if you want to visit Moscow in 2 days, you can include this island in your itinerary between the cathedral and Gorky park. Here is the old confectionery factory Krasny Oktyabr, which has gradually turned into a fashionable micro-district. There are then some elements of street art, cafes and restaurants and some Moscow bohemian side. At the end of the island you can see a gigantic 98-meter-high monument dedicated to the Russian reforming tsar Pierre The Great.

Good to know! You can find on this island are the trendiest nightclubs in Moscow. On weekends, there are taxi caps after midnight so there are so many people. On the other hand, if you go there in winter and during the day, the island is quite empty and less interesting to see.

Gorky Park is one of the TOP places to visit in Moscow, because it allows you to better understand the life of the locals and their rhythm. In fact, it’s a huge entertainment park. For example, in winter there is a giant ice rink and in summer – free dance or yoga lessons, sandy beaches for playing volleyball, an outdoor cinema. So, like the locals, have a Stakantchik (ice cream or cooked corn), and enjoy the atmosphere of the place: that’s one of the interesting things to do in Moscow to discover the city.

  • Where? Krymsky Val 9. 20 minutes’ walk from Krasny Oktyabr, along the quays.

Sparrow Hill and Moscow State University

The Sparrow Hill, Vorobiovy Gori in Russian, is the highest point in Moscow. It is rather known to Russians, but less to travelers. A nice view on Moscow opens from the hill, and in particular on the Luzhniki Stadium. In addition, on the hill itself is the Moscow State University: an impressive skyscraper from the Soviet era.

  • How to get there? By bus T7 (35 min) from Oktyaborskaya station, near Gorki Park. By metro (Vorobiovy Gorki station) + climb the hill on foot. On foot along the Moskva along the Gorky Park (1h30) + climb in funiculars.

Good to know! It is possible to cross the Moskva river by funicular. We actually tested it and it was pretty cool! That is one of our favorite things to do in Moscow!

What to do in Moscow

What to do in Moscow in 3 days?

If you are going to visit Moscow in 3 days, it would be interesting to dive into the Soviet era which strongly marked the country and the city. After the Bolshevik Revolution, the capital was transferred from Saint Petersburg to Moscow, in order to mark the change of power. Moscow then became the world showcase for communist ideology. Here are the best things to do in Moscow for 3-day-trip!

VDNKh, visit Moscow of the Soviet era

VDNKh is a large exhibition center in the north of Moscow, where there are still several striking witnesses of the USSR. The most interesting are the Museum of Cosmonauts and the Statue of the Worker and the Kolkhozian , which will certainly impress you with its size!

Visit

GULAG History Museum

The explanations of the museum are very well done. We really have the feeling of going back in time. If you are going to visit Moscow in 3 days and you are interested in history and this subject in particular, I recommend this museum. Visit the GULAG History Museum is one of the most interesting things to do in Moscow.

hpi for well visit

Discover the Patriarche Pounds district

It’s a nice neighborhood in Moscow where you can come across rather affluent locals, but not necessarily very bling-bling. Take a walk in this area is really a cool thing to do in Moscow! In addition, the Ponds of Patriarch is one of the places of Bulgakov’s novel “Master and Margarita”. As this is an interesting area to see, we have included it in a walking tour of Moscow. The route ends at the Moscow Kremlin, which is very convenient, because you will be able to visit Moscow in 3 days by optimizing your trips.

hpi for well visit

What to visit in Moscow in 4 days: TOP things to do in Moscow in 4 days

If you want to visit Moscow in 3 days, you will already see a lot of things. On the other hand, if you stay one more day, you have plenty to do! The Novodevichy Convent, the Tchistie Proudy district and the Izmaylovo Kremlin are very good candidates for you, if you are going to visit Moscow in 4 days.

Visiting Novodevichy Convent in Moscow

The Novodevichy Convent is one of the most brilliant examples of Russian architecture, according to UNESCO. This beautiful complex was built in 1524 and today consists of the convent, but also of a cemetery whose status could be compared to that of Père-Lachaise in Paris. Visiting Novodevichy Convent is one of the great things to do in Moscow, if you want to go a little bit outside of the center!

What to see in Moscow in one day

Discovering Tchistye Proudy district

It’s one of the most popular areas of Moscow, with many cafes, restaurants and bars nearby. It is therefore a place to discover if you want to visit Moscow in 4 days. It is just as pleasant for a stroll as for the discovery of local life. For example, in winter the pond turns into an ice rink.

Visiting the Izmaylovo Kremlin, one of the coolest things to do in Moscow!

The Izmaylovo Kremlin is more of a tourist than a historic place. On the other hand, it is a pretty impressive place to discover, especially on weekends. Inside the Kremlin, there is a flea market where you can find a little bit of everything, but mostly good souvenirs to bring from Moscow. For example, chapka, traditional Russian scarves or matryoshka (Russian dolls). Add the Kremlin and the Izmaïlovo market to your itinerary if you are going to visit Moscow in 4 days, because it is a nice and very colorful place! Visiting the Izmailovo Kremlin is one of the things to do in Moscow, if you want to put colors in your Instagram account! 😉

Things to do Moscow blog

In 4 days, we will have the opportunity to see several Moscow: Classic Moscow, Moscow of old Russia, Soviet Moscow and a little bit of the new Moscow. So what to visit in Moscow on the 5th day of travel?

What to visit in Moscow in 5 days?

Art lovers will be delighted to discover the Tretyakov Gallery and the Pushkin Museum of Fine Arts, while others will prefer to stroll along Arbat Street, see the buildings of Moskva-City or visit Bunker 42.

Admiring Russian art at Tretyakov Gallery

Founded in 1856 by an industrialist and great lover of art, the gallery has grown over the decades, and then bequeathed to the state. Today the collection includes more than 140,000 pieces, 15,000 of which are paintings. Visiting the Tretyakov Gallery is one of the things to do in Moscow if you want to discover Russian art!

  • Where? Pereoulok Lavrouchinski 10. A 5-minute walk from Tretiakovskaya station
  • Opening hours. Open from 10 a.m. to 6 p.m. until 9 p.m. Thursday and Friday. Closed on Mondays.
  • Entry tickets. 500 RUB.

Museum to see

Visiting the Pushkin Museum of Fine Arts

The Pushkin Museum of Fine Arts presents the treasures of ancient Egypt, the paintings of Rembrandt and Cézanne, a fine collection of Impressionism.

  • Where? Ulitsa Volkhonka 12
  • Opening hours. Daily: 10: 00-20: 00, except Thursday: 11: 00-21: 00. Closed on Mondays. The boxes close an hour before closing.
  • Entry tickets. The prices vary according to the collections from 300 to 750 RUB.

Walking on Arbat Street

All Russians know Rue Arbat. So, walking on Arbat street is one of the things to do in Moscow. However, after the years, little by little it became very touristy. This is a pedestrian street only. There are souvenir shops, restaurants and cafes there, but it is no longer the most authentic neighborhood in the city.

hpi for well visit

Seeing the buildings of Moskva-City (Moscow City)

Moskva-City is Moscow’s business center, much like Paris’s Defense district. The skyscrapers of Moskva-City are among the tallest in Europe: 373 meters high! Very nice place to see at dusk.

Good to know! You can admire a nice view of Moscow City from the docks of Tarasa Shevchenko. It’s especially beautiful in the evening with all the lights on.

Bunker 42, one of the most unusual things to do in Moscow

Bunker 42 is a secret military complex which was to be used by the Soviets in the event of a nuclear attack: a space of 7000 m² 65 meters underground!

  • Where? 5 Kotelnitcheski Lane, 11.
  • Prices. 2200 RUB per person
  • Opening hours. Open daily from 10 a.m. to 8 p.m.
  • Restaurant inside. Original, but rather a tourist trap.

hpi for well visit

What to visit in Moscow in 6 days or more?

There are still so many places to see, because Moscow is a big megalopolis and there is always something exciting to do there. For example: the ancient Kolomenskoye village or the WINZAVOD contemporary art center .

If you are interested in history and want to see Russian cities on a rather “human scale”, it would certainly be interesting for you to discover the cities of the Golden Ring . For example, it is very easy to get to Sergey Posad from Moscow (less than 2 hours in train). Visiting the Golden Ring is one of the best things to do in Moscow if you are staying more than a 5-6 days.

There are still plenty of places to see in Moscow, however I did my best to list here the best things to do in Moscow, what to see in Moscow in one day, but also in 2, 3, 4 or 5 days in Moscow!

Moscow travel tips:

  • Airport transfer: how to go to Moscow?
  • Where to stay in Moscow (hotels, districts)?
  • Tourist voucher for Russian visa
  • Christmas and New Year in Moscow
  • What is the best time to visit Moscow?

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Elmo’s wellness check uncovers existential dread and despair on social media

Thousands of people are unloading their life problems on Elmo this week after the red Muppet posed a casual question on X: “How is everybody doing?”

Not well, it seems.

In fact, the question, which was posted to X on Monday, opened the floodgates to a deluge of internet users eager to vent to the children’s show character that had somehow signed himself up to be the internet’s newest therapist.

“Elmo I’m suffering from existential dread over here,” a user replied .

“Every morning, I cannot wait to go back to sleep. Every Monday, I cannot wait for Friday to come,” another user wrote . “Every single day and every single week for life.”

Even some celebrities joined in on the collective grievance-airing. Actor Rachel Zegler said she was “resisting the urge to tell elmo that i am kinda sad.”

Some joked that such a massive trauma dump must be too much for the poor puppet to handle.

All Elmo did was ask a simple question, but the responses were so overwhelming that “Sesame Street’s” official X account shared a link to mental health resources .

Aaron Bisman, the vice president of audience development at Sesame Workshop, said the "grown-ups" helping Elmo and other characters from the show with their social media accounts are "cognizant of the relationship that audiences have developed" with them over the last 54 years.

"Many of our social posts are designed to make audiences smile or laugh, while others promote and share resources for kids children and their parents, caregivers, and loved ones who make up their circle of care," Bisman said.

“Leveraging the interest in Elmo’s tweet to posting the quote tweet from Sesame Street with emotional wellbeing resources is exactly what Sesame Workshop was created to do."

Still, the Muppet appears to be trying his best to keep up.

“Wow! Elmo is glad he asked! Elmo learned that it is important to ask a friend how they are doing,” he wrote in a follow-up post. “Elmo will check in again soon, friends!  Elmo loves you.❤️ #EmotionalWellBeing”

Some, such as the singer-songwriter T-Pain, expressed appreciation for Elmo’s empathy.

“That’s love, pull up any time bruh,” he wrote . “Check in on your people 🙏🏿”

There were also people online who then wondered whether Elmo himself might need some love.

"Has anyone checked on you @elmo?" asked an X user .

hpi for well visit

Angela Yang is a culture and trends reporter for NBC News.

We're All Med Here

Medical School/Pre-med blog

Tag: how to write an HPI

HPI Template: General/Well exam

HPI Template: General/Well exam

Yo. What’s up?

I’ve honestly wanted to do a more specific post like this because it is highly searched, but I’ve also been dreading doing it.

Simply put: writing an HPI is hard. It is usually hard to find a template as everyone has their own style. Some are longer, more eloquently put and flow great. Some are short and choppy in style. It really all depends on your preferences, your provider’s preferences, and sometimes the specialty.

So, I’m going to attempt to do a general template for you. Again, most of this you just have to PRACTICE. It really is the only way to get good at HPI’s.

What is a well exam?

Ah. So glad you asked.

A well exam is usually a yearly exam for your checkups. Can be called annual exam, well exam, general medical exam, etc. Typically when you are a pediatric patient, you have many well exams in a year. For example, you will be seen at 1 week post-life, then like 1 month, 2 months, 4 months, 6 months, etc. Once you reach about the age of 2 or 3 you start seeing a pediatrician yearly. After that (especially as an adult), you should really have a comprehensive medical exam with your doctor once a year.

Now, if you have chronic conditions, you are likely going to have to see your doctor more regularly. But they can at least count one of those visits as a yearly exam which is less of a cost to your insurance.

Additionally, most adults’ jobs will give discounts if you go to your yearly exam to show you are trying to stay healthy. I don’t know why some jobs seem to care about this, but they do.

Okay back to the template

By now you should know what a SOAP note template looks like. If not, go check out my other scribe series posts. It’s all in there. If you have, I’m going to skip all the additional stuff and just focus on the HPI.

Super basic, no flare:

{First name, last name} is a {age} y/o {sex} presenting with a cc of {location if applicable} {chief complaint} which started {onset}. Symptom is described as {character/quality}, last for {duration}, and is described as a {0-10/10, severity} on the pain scale. It. {does/doesn’t} radiate to {location}, and is noted mostly at {timing}. {List of aggravating symptoms} exacerbate/aggravate {cc}. While {list of alleviating symptoms} improve {cc}. Associated symptoms include {List of associating symptoms}. {List negative associated symptoms}. There are no other concerns/complaints at this time.

It looks like this:

Mr. {Judge X} is a {55} y/o {M} presenting with a cc of {RLQ} {abdominal pain} onset {15 hours ago}. Initially, pain was around his umbilicus, but has now settled to his RLQ. It is described as {sharp}, and at first was {waxing and waning} but is now {constant}. Pain is currently rated an {8/10}. It {does not} radiate. {Hitting bumps on the car ride over} aggravated his pain. He has tried {Tylenol, Motrin, and Pepto-Bismol} without relief. Associated symptoms include {nausea, vomiting x1, low grade fever of 100.4’F at home, and chills}. {No reported hematemesis, diarrhea, hematochezia, chest pain}, DIB, or other symptoms.

Template when there are multiple complaints

So. As much as life would be really easy if there was only one complaint that someone came in with, people don’t just do that. A lot of times, they have several chronic diseases that are managed. Other times they wait a very long time before being seen, and then come in with several complaints that they would like addressed. These templates need to be a bit more broken down.

Basic, multiple complaint template:

{First name, last name} is a {age} y/o {sex} presenting for a generalized well examination.

{His/Her} first concern, {main complaint}. They first noted {his/her} {complaint} {onset}. Symptom is described as {character/quality}, last for {duration}, and is described as a {0-10/10, severity} on the pain scale. It. {does/doesn’t} radiate to {location}, and is noted mostly at {timing}. {List of aggravating symptoms} exacerbate/aggravate {cc}. While {list of alleviating symptoms} improve {cc}. Associated symptoms include {List of associating symptoms JUST FOR THIS COMPLAINT}. {List negative associated symptoms JUST FOR THIS COMPLAINT}.

You only want to add negative and associated symptoms that correlate with that complaint. This may not be a long list. That is okay.

You can then add as many similar paragraphs to additional complaints.

In regards to {his/her} {chronic condition}, they have been doing {well, poor}. They have been {compliant/non-compliant} with their medications, which include {list their medications and doses}. They have tried/incorporated {lifestyle changes} with good measure. Their last {objective finding related to this disease/condition}. {List associated symptoms if any}. {List negative associated symptoms if any}.

You can then add several similar paragraphs if they have multiple chronic conditions.

For example:

{Miss Sanchez} is a {32 y/o} {F} presenting today for a generalized well examination.

In regards to {her} {diabetes}, she has been doing {fairly well} per her reports. She has been {compliant} with her metformin and glipizide on her current regimen. She has tried to {cut out sodas and limits her caffeine intake to 1-2 coffees a day}. She additionally tries to walk around the block after work and on her lunch break. However, she has not made progress with much other changes to her lifestyle. She does not often check her sugars at home. Her last {hgb A1C was 8.0}. Today, her hgb A1C is {7.9}. She denies any {paresthesias, weight gain, eye changes, or urinary complaints}. She has not gone for her annual eye exam yet.

Things to think about per complaint:

  • Diabetes: medication compliance, diet/exercise changes, weight gain/loss, Hemoglobin A1c results (more reliable than glucose levels on a BMP), any new symptoms they are having. The three big things with diabetes is diabetic retinopathy, nephropathy, and peripheral neuropathy. Or eyes, kidneys, and tips of the extremities. They should be seen every 3 months for glucose checks, should be checking their sugars at home, should have an annual eye exam, and should have their urine monitored for protein and glucose at least yearly. Additionally, a diabetic foot exam should be performed once a year (some providers like to do it twice a year).
  • Hypertension: medication compliance, monitoring blood pressures at home, diet/exercise changes. Losing 10% of your body weight can actually resolve or improve a lot of chronic diseases (including improving diabetes and hypertension). Other things to think about include hyperlipidemia, so a yearly lipid panel check should be done as well. Overall, most of this discussion will be medication compliance and lifestyle changes.
  • Thyroid checks: The main blood test ordered is TSH, but you will also see FT3/4 also sent. Most of the patients you will see will already be on medication, and this is simply checking to make sure the medication dosage doesn’t need to be changed. As a scribe, you won’t really need to be doing much else with this information. But if the patient is being newly diagnosed, then a high TSH indicates hypothyroidism, and a low TSH indicates hyperthyroidism. Usually follow up tests such as a thyroid ultrasound would also be ordered to confirm that there isn’t anything else occurring, so add this information in if your provider likes that information in their HPI. Otherwise, the medication dosage and frequency is important along with any possible symptoms the patient is having.
  • Chronic lung complaints: Common things to add include when the last PFT was (lung function testing), last CXR, if they are on inhalers, what they are, dosage, etc; how often they are using rescue inhalers, the type of work they do, if they are exposed to smokers, if they are a smoker, things like that. Worsening symptoms include sputum production, increased coughing, and dyspnea. These patients can tend to have COPD exacerbations more frequently as the disease progresses or isn’t well controlled, and they tend to get pneumonia very easily.
  • Well Woman exam: The main thing here is when was her last exam, any prior positive HPV testing (and what it showed, such as ASCUS vs low vs high dysplasia), and if those resulted in any procedures previously. Last mammogram or ultrasound or MRI (depending on age), last menstrual period, previous pregnancies (included as GPA, or gravid, para, and abortions), age when her menstrual cycle started, if she is in menopause/when did that occur.
  • Vaccinations: These are mostly age specific. In a pediatric population, there are many more vaccinations to keep track of. In the elderly, there are a few that are important. Otherwise, you will usually see tetanus as a big one being asked in the ED regardless of the age. You basically want to know what vaccination and when/how long ago they had it.
  • Additional cancer screenings: There are a lot. For example, gynecologic screenings, breast screenings, colon cancer screenings, lung cancer screenings… you get my point. Each has a specific set of questions and age requirements. Usually your doctor will be the one to ask, you just need to put if they have or haven’t. If they have, what age the screening was done/how long ago and what the results were.

General Information for the plan

Yes, well exams tend to take a while simply because you need to have a thorough examination. And if you are just writing the note, it means more things for you to click/type out. However, not every well exam you do will be daunting. And neither will the note. Typically most people don’t have several complaints and are just there to get yearly bloodwork and a pat on the back. However, you will have people with a list of complaints/concerns and then you have a massive HPI and usually a larger plan.

But well exams aren’t just the large HPI’s. The plan is also important. General health information gets relayed here along with information for each complaint. Several of the complaints listed in the above section go over areas that need to be counseled on. You may end up discussing a lot of this or majority of this information. When one of your providers frequently has a spiel about something, I suggesting making a “dot phrase” or quick phrase. That way, you can just pull it into the note and you don’t have to re-type it all the time.

Additional things:

  • Counseling on diet and exercise.
  • Exercise prescriptions
  • RICE instructions
  • how to measure your blood pressure
  • low salt diet
  • home safety
  • General discussion about labwork/imaging
  • general discussion about what to return for/call/go to the emergency department for

Again, depending on the encounter will depend on what is brought up. Once you see a few you will start to get the hang of it. As a scribe, if you can’t pick up well and run with it you won’t make it very far. As a medical student, PA student, or nursing student, you should have enough background to trigger this knowledge to help you run with it. That is what you are being trained to do after all!

Anywho, good luck and cheers!

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Scribe Series: HPI Practice Case 2

Scribe Series: HPI Practice Case 2

Hello medhatters!

I have another case for you all! Like the previous post, I will give you a scenario with a few questions to answer. The goal is to improve your HPI writing. Again, since this isn’t audio recorded, this will not help with your listening & typing skills. It will however, help you improve your flow and if you can properly pick out which elements are what. Since looking at the problem is easier when trying to solve it than listening to it, we will do that again today.

Like the last practice, I have a practice worksheet for you. Please feel free to either copy it and pull it up and work on it, or print it out. I will not be allowing editing access simply so it stays blank for others when they come across it. Worksheet Here.

Case: Chest Pain

Complaints:

  • Chest pain while watching television earlier tonight
  • Goes to left arm
  • Goes up to jaw
  • Nausea, he vomited once.
  • Has not improved with drinking water. Nothing made it better or worse at home.
  • Called EMS, they gave him some medicine that he doesn’t know the name of that seemed to help a little bit, but now his chest pain is back.
  • He has never had this before.
  • H/o HTN, CAD.

Task 1: Can you pick out the elements of this HPI?

Age/Sex Chief Complaint Onset Location Duration Characteristic Alleviating factors Aggravating factors Associated Symptoms Radiation Timing Severity (anything else you can add at the bottom of your paragraph).

Now, there are actually two problems here. But we are going to lump the lesser problem into the main problem, simply because I’m going for one caused the other.

Age/Sex: 61 y/o M CC: Chest pain Onset: earlier tonight while watching television Location: substernal Duration: constant (implied here). Characteristic: sharp and squeezing Alleviating factors: nothing at home, including attempting to drink water. But some improvement with EMS medication administration Aggravating factors: none Associated symptoms: nausea & vomiting x1 Radiation: to left arm and jaw Timing: since pain is constant we don’t really have a timing specific element in this story. Severity: 9/10 Everything else: We have some backstory here. The main thing to look at is the history of (h/o) hypertension (HTN) and coronary artery disease (CAD). We also know he has never had this before.

I want you to stop and think about what this might be.  What might the medication have been that EMS gave?

Task 2: Write an HPI!

Write an HPI so that your order, flow and story makes sense. Use medical terminology as if you were writing this in a chart. The blessing is this is text, and you aren’t converting it from what you are hearing down into text form.

My version of this HPI:

Patient is a 61 y/o M with a h/o HTN and CAD, presenting for sudden onset substernal chest pain while sitting down watching television tonight. He describes his pain as a sharp and squeezing sensation, rated a 9/10 which radiates to his L arm and jaw. He has had nausea and vomiting x1. The patient noted no improvement with drinking water at home, but upon EMS arrival he was given sublingual NTG with brief improvement before his pain returned. No reported aggravating factors. He denies having this previously and has no other concerns or complaints.

On exam, he is diaphoretic, tachycardic, and in distress. You immediately hook him up to an EKG and find he is in normal sinus rhythm. His heart rate is 105 BPM. On his strip, he has ST depression in leads 2,3, and AVF.

His radial and DP pulses are 2+ and equal. His lungs are clear to auscultation bilaterally. Abdomen is benign. He is alert and oriented, but nervous.

You order a chest X-ray (CXR), a troponin, CBC, & CMP. You start him on oxygen, IV morphine, and give him a baby ASA. He was started in a Nitro drip.

Task 3: Can you guess what happened?

This is a pretty classic case here. I hope even if you don’t know what some of this medical treatment is, you would be able to guess it!

He is having a STEMI, or an ST elevated myocardial infarction. This is an inferior MI, which means it is likely affecting the RCA or right coronary artery. So we are essentially not getting enough blood flow to the right atrium and right ventricle right now. Not good!

Since we started his initial treatment, and the doctor gave him pain medications and more nitroglycerin in attempts to relax his arteries to get more blood flow to the heart. The next step is to call the cardiologist in hopes of getting him to the Cath lab. We want to open those arteries up as quickly as possible before damaging more tissue.

So our diagnoses (or Assessment!) is as follows:

  • Chest pain, Inferior STEMI

You may also hear the terms ACS or acute coronary syndrome which encompasses both MI’s and angina.

Hopefully you enjoyed this practice HPI post! Let me know if this helped in the comments below.

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Travel Itinerary For One Week in Moscow: The Best of Moscow!

I just got back from one week in Moscow. And, as you might have already guessed, it was a mind-boggling experience. It was not my first trip to the Russian capital. But I hardly ever got enough time to explore this sprawling city. Visiting places for business rarely leaves enough time for sightseeing. I think that if you’ve got one week in Russia, you can also consider splitting your time between its largest cities (i.e. Saint Petersburg ) to get the most out of your trip. Seven days will let you see the majority of the main sights and go beyond just scratching the surface. In this post, I’m going to share with you my idea of the perfect travel itinerary for one week in Moscow.

Moscow is perhaps both the business and cultural hub of Russia. There is a lot more to see here than just the Kremlin and Saint Basil’s Cathedral. Centuries-old churches with onion-shaped domes dotted around the city are in stark contrast with newly completed impressive skyscrapers of Moscow City dominating the skyline. I spent a lot of time thinking about my Moscow itinerary before I left. And this city lived up to all of my expectations.

7-day Moscow itinerary

Travel Itinerary For One Week in Moscow

Day 1 – red square and the kremlin.

Metro Station: Okhotny Ryad on Red Line.

No trip to Moscow would be complete without seeing its main attraction. The Red Square is just a stone’s throw away from several metro stations. It is home to some of the most impressive architectural masterpieces in the city. The first thing you’ll probably notice after entering it and passing vendors selling weird fur hats is the fairytale-like looking Saint Basil’s Cathedral. It was built to commemorate one of the major victories of Ivan the Terrible. I once spent 20 minutes gazing at it, trying to find the perfect angle to snap it. It was easier said than done because of the hordes of locals and tourists.

As you continue strolling around Red Square, there’s no way you can miss Gum. It was widely known as the main department store during the Soviet Era. Now this large (yet historic) shopping mall is filled with expensive boutiques, pricey eateries, etc. During my trip to Moscow, I was on a tight budget. So I only took a retro-style stroll in Gum to get a rare glimpse of a place where Soviet leaders used to grocery shop and buy their stuff. In case you want some modern shopping experience, head to the Okhotny Ryad Shopping Center with stores like New Yorker, Zara, and Adidas.

things to do in Moscow in one week

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To continue this Moscow itinerary, next you may want to go inside the Kremlin walls. This is the center of Russian political power and the president’s official residence. If you’re planning to pay Kremlin a visit do your best to visit Ivan the Great Bell Tower as well. Go there as early as possible to avoid crowds and get an incredible bird’s-eye view. There are a couple of museums that are available during designated visiting hours. Make sure to book your ticket online and avoid lines.

Day 2 – Cathedral of Christ the Saviour, the Tretyakov Gallery, and the Arbat Street

Metro Station: Kropotkinskaya on Red Line

As soon as you start creating a Moscow itinerary for your second day, you’ll discover that there are plenty of metro stations that are much closer to certain sites. Depending on your route, take a closer look at the metro map to pick the closest.

The white marble walls of Christ the Saviour Cathedral are awe-inspiring. As you approach this tallest Orthodox Christian church, you may notice the bronze sculptures, magnificent arches, and cupolas that were created to commemorate Russia’s victory against Napoleon.

travel itinerary for one week in Moscow

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Unfortunately, the current Cathedral is a replica, since original was blown to bits in 1931 by the Soviet government. The new cathedral basically follows the original design, but they have added some new elements such as marble high reliefs.

Home to some precious collection of artworks, in Tretyakov Gallery you can find more than 150,000 of works spanning centuries of artistic endeavor. Originally a privately owned gallery, it now has become one of the largest museums in Russia. The Gallery is often considered essential to visit. But I have encountered a lot of locals who have never been there.

Famous for its souvenirs, musicians, and theaters, Arbat street is among the few in Moscow that were turned into pedestrian zones. Arbat street is usually very busy with tourists and locals alike. My local friend once called it the oldest street in Moscow dating back to 1493. It is a kilometer long walking street filled with fancy gift shops, small cozy restaurants, lots of cute cafes, and street artists. It is closed to any vehicular traffic, so you can easily stroll it with kids.

Day 3 – Moscow River Boat Ride, Poklonnaya Hill Victory Park, the Moscow City

Metro Station: Kievskaya and Park Pobedy on Dark Blue Line / Vystavochnaya on Light Blue Line

Voyaging along the Moscow River is definitely one of the best ways to catch a glimpse of the city and see the attractions from a bit different perspective. Depending on your Moscow itinerary, travel budget and the time of the year, there are various types of boats available. In the summer there is no shortage of boats, and you’ll be spoiled for choice.

exploring Moscow

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If you find yourself in Moscow during the winter months, I’d recommend going with Radisson boat cruise. These are often more expensive (yet comfy). They offer refreshments like tea, coffee, hot chocolate, and, of course, alcoholic drinks. Prices may vary but mostly depend on your food and drink selection. Find their main pier near the opulent Ukraine hotel . The hotel is one of the “Seven Sisters”, so if you’re into the charm of Stalinist architecture don’t miss a chance to stay there.

The area near Poklonnaya Hill has the closest relation to the country’s recent past. The memorial complex was completed in the mid-1990s to commemorate the Victory and WW2 casualties. Also known as the Great Patriotic War Museum, activities here include indoor attractions while the grounds around host an open-air museum with old tanks and other vehicles used on the battlefield.

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The hallmark of the memorial complex and the first thing you see as you exit metro is the statue of Nike mounted to its column. This is a very impressive Obelisk with a statue of Saint George slaying the dragon at its base.

Maybe not as impressive as Shanghai’s Oriental Pearl Tower , the skyscrapers of the Moscow City (otherwise known as Moscow International Business Center) are so drastically different from dull Soviet architecture. With 239 meters and 60 floors, the Empire Tower is the seventh highest building in the business district.

The observation deck occupies 56 floor from where you have some panoramic views of the city. I loved the view in the direction of Moscow State University and Luzhniki stadium as well to the other side with residential quarters. The entrance fee is pricey, but if you’re want to get a bird’s eye view, the skyscraper is one of the best places for doing just that.

Day 4 – VDNKh, Worker and Collective Farm Woman Monument, The Ostankino TV Tower

Metro Station: VDNKh on Orange Line

VDNKh is one of my favorite attractions in Moscow. The weird abbreviation actually stands for Russian vystavka dostizheniy narodnogo khozyaystva (Exhibition of Achievements of the National Economy). With more than 200 buildings and 30 pavilions on the grounds, VDNKh serves as an open-air museum. You can easily spend a full day here since the park occupies a very large area.

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First, there are pavilions that used to showcase different cultures the USSR was made of. Additionally, there is a number of shopping pavilions, as well as Moskvarium (an Oceanarium) that features a variety of marine species. VDNKh is a popular venue for events and fairs. There is always something going on, so I’d recommend checking their website if you want to see some particular exhibition.

A stone’s throw away from VDNKh there is a very distinctive 25-meters high monument. Originally built in 1937 for the world fair in Paris, the hulking figures of men and women holding a hammer and a sickle represent the Soviet idea of united workers and farmers. It doesn’t take much time to see the monument, but visiting it gives some idea of the Soviet Union’s grandiose aspirations.

I have a thing for tall buildings. So to continue my travel itinerary for one week in Moscow I decided to climb the fourth highest TV tower in the world. This iconic 540m tower is a fixture of the skyline. You can see it virtually from everywhere in Moscow, and this is where you can get the best panoramic views (yep, even better than Empire skyscraper).

top things to do in Moscow

Parts of the floor are made of tempered glass, so it can be quite scary to exit the elevator. But trust me, as you start observing buildings and cars below, you won’t want to leave. There is only a limited number of tickets per day, so you may want to book online. Insider tip: the first tour is cheaper, you can save up to $10 if go there early.

Day 5 – A Tour To Moscow Manor Houses

Metro Station: Kolomenskoye, Tsaritsyno on Dark Green Line / Kuskovo on Purple Line

I love visiting the manor houses and palaces in Moscow. These opulent buildings were generally built to house Russian aristocratic families and monarchs. Houses tend to be rather grand affairs with impressive architecture. And, depending on the whims of the owners, some form of a landscaped garden.

During the early part of the 20th century though, many of Russia’s aristocratic families (including the family of the last emperor) ended up being killed or moving abroad . Their manor houses were nationalized. Some time later (after the fall of the USSR) these were open to the public. It means that today a great many of Moscow’s finest manor houses and palaces are open for touring.

one week Moscow itinerary

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There are 20 manor houses scattered throughout the city and more than 25 in the area around. But not all of them easily accessible and exploring them often takes a lot of time. I’d recommend focusing on three most popular estates in Moscow that are some 30-minute metro ride away from Kremlin.

Sandwiched between the Moscow River and the Andropov Avenue, Kolomenskoye is a UNESCO site that became a public park in the 1920’s. Once a former royal estate, now it is one of the most tranquil parks in the city with gorgeous views. The Ascension Church, The White Column, and the grounds are a truly grand place to visit.

You could easily spend a full day here, exploring a traditional Russian village (that is, in fact, a market), picnicking by the river, enjoying the Eastern Orthodox church architecture, hiking the grounds as well as and wandering the park and gardens with wildflower meadows, apple orchards, and birch and maple groves. The estate museum showcases Russian nature at its finest year-round.

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If my travel itinerary for one week in Moscow was a family tree, Tsaritsyno Park would probably be the crazy uncle that no-one talks about. It’s a large park in the south of the city of mind-boggling proportions, unbelievable in so many ways, and yet most travelers have never heard of it.

The palace was supposed to be a summer home for Empress Catherine the Great. But since the construction didn’t meet with her approval the palace was abandoned. Since the early 1990’s the palace, the pond, and the grounds have been undergoing renovations. The entire complex is now looking brighter and more elaborately decorated than at possibly any other time during its history. Like most parks in Moscow, you can visit Tsaritsyno free of charge, but there is a small fee if you want to visit the palace.

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Last, but by no means least on my Moscow itinerary is Kuskovo Park . This is definitely an off-the-beaten-path place. While it is not easily accessible, you will be rewarded with a lack of crowds. This 18th-century summer country house of the Sheremetev family was one of the first summer country estates of the Russian nobility. And when you visit you’ll quickly realize why locals love this park.

Like many other estates, Kuskovo has just been renovated. So there are lovely French formal garden, a grotto, and the Dutch house to explore. Make sure to plan your itinerary well because the estate is some way from a metro station.

Day 6 – Explore the Golden Ring

Creating the Moscow itinerary may keep you busy for days with the seemingly endless amount of things to do. Visiting the so-called Golden Ring is like stepping back in time. Golden Ring is a “theme route” devised by promotion-minded journalist and writer Yuri Bychkov.

Having started in Moscow the route will take you through a number of historical cities. It now includes Suzdal, Vladimir, Kostroma, Yaroslavl and Sergiev Posad. All these awe-inspiring towns have their own smaller kremlins and feature dramatic churches with onion-shaped domes, tranquil residential areas, and other architectural landmarks.

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I only visited two out of eight cities included on the route. It is a no-brainer that Sergiev Posad is the nearest and the easiest city to see on a day trip from Moscow. That being said, you can explore its main attractions in just one day. Located some 70 km north-east of the Russian capital, this tiny and overlooked town is home to Trinity Lavra of St. Sergius, UNESCO Site.

things to do in Moscow in seven days

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Sergiev Posad is often described as being at the heart of Russian spiritual life. So it is uncommon to see the crowds of Russian pilgrims showing a deep reverence for their religion. If you’re traveling independently and using public transport, you can reach Sergiev Posad by bus (departs from VDNKh) or by suburban commuter train from Yaroslavskaya Railway Station (Bahnhof). It takes about one and a half hours to reach the town.

Trinity Lavra of St. Sergius is a great place to get a glimpse of filling and warming Russian lunch, specifically at the “ Gostevaya Izba ” restaurant. Try the duck breast, hearty potato and vegetables, and the awesome Napoleon cake.

Day 7 – Gorky Park, Izmailovo Kremlin, Patriarch’s Ponds

Metro Station: Park Kultury or Oktyabrskaya on Circle Line / Partizanskaya on Dark Blue Line / Pushkinskaya on Dark Green Line

Gorky Park is in the heart of Moscow. It offers many different types of outdoor activities, such as dancing, cycling, skateboarding, walking, jogging, and anything else you can do in a park. Named after Maxim Gorky, this sprawling and lovely park is where locals go on a picnic, relax and enjoy free yoga classes. It’s a popular place to bike around, and there is a Muzeon Art Park not far from here. A dynamic location with a younger vibe. There is also a pier, so you can take a cruise along the river too.

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The Kremlin in Izmailovo is by no means like the one you can find near the Red Square. Originally built for decorative purposes, it now features the Vernissage flea market and a number of frequent fairs, exhibitions, and conferences. Every weekend, there’s a giant flea market in Izmailovo, where dozens of stalls sell Soviet propaganda crap, Russian nesting dolls, vinyl records, jewelry and just about any object you can imagine. Go early in the morning if you want to beat the crowds.

All the Bulgakov’s fans should pay a visit to Patriarch’s Ponds (yup, that is plural). With a lovely small city park and the only one (!) pond in the middle, the location is where the opening scene of Bulgakov’s novel Master and Margarita was set. The novel is centered around a visit by Devil to the atheistic Soviet Union is considered by many critics to be one of the best novels of the 20th century. I spent great two hours strolling the nearby streets and having lunch in the hipster cafe.

Conclusion and Recommendations

To conclude, Moscow is a safe city to visit. I have never had a problem with getting around and most locals are really friendly once they know you’re a foreigner. Moscow has undergone some serious reconstruction over the last few years. So you can expect some places to be completely different. I hope my one week Moscow itinerary was helpful! If you have less time, say 4 days or 5 days, I would cut out day 6 and day 7. You could save the Golden Ring for a separate trip entirely as there’s lots to see!

What are your thoughts on this one week Moscow itinerary? Are you excited about your first time in the city? Let me know in the comments below!

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24 comments.

hpi for well visit

Ann Snook-Moreau

Moscow looks so beautiful and historic! Thanks for including public transit information for those of us who don’t like to rent cars.

hpi for well visit

MindTheTravel

Yup, that is me 🙂 Rarely rent + stick to the metro = Full wallet!

hpi for well visit

Mariella Blago

Looks like you had loads of fun! Well done. Also great value post for travel lovers.

Thanks, Mariella!

hpi for well visit

I have always wanted to go to Russia, especially Moscow. These sights look absolutely beautiful to see and there is so much history there!

Agree! Moscow is a thousand-year-old city and there is definitely something for everyone.

hpi for well visit

Tara Pittman

Those are amazing buildings. Looks like a place that would be amazing to visit.

hpi for well visit

Adriana Lopez

Never been to Moscow or Russia but my family has. Many great spots and a lot of culture. Your itinerary sounds fantastic and covers a lot despite it is only a short period of time.

What was their favourite thing about Russia?

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Gladys Parker

I know very little about Moscow or Russia for the\at matter. I do know I would have to see the Red Square and all of its exquisite architectural masterpieces. Also the CATHEDRAL OF CHRIST THE SAVIOUR. Thanks for shedding some light on visiting Moscow.

Thanks for swinging by! The Red Square is a great starting point, but there way too many places and things to discover aside from it!

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Ruthy @ Percolate Kitchen

You are making me so jealous!! I’ve always wanted to see Russia.

hpi for well visit

Moscow is in my bucket list, I don’t know when I can visit there, your post is really useful. As a culture rich place we need to spend at least week.

hpi for well visit

DANA GUTKOWSKI

Looks like you had a great trip! Thanks for all the great info! I’ve never been in to Russia, but this post makes me wanna go now!

hpi for well visit

Wow this is amazing! Moscow is on my bucket list – such an amazing place to visit I can imagine! I can’t wait to go there one day!

hpi for well visit

The building on the second picture looks familiar. I keep seeing that on TV.

hpi for well visit

Reesa Lewandowski

What beautiful moments! I always wish I had the personality to travel more like this!

hpi for well visit

Perfect itinerary for spending a week in Moscow! So many places to visit and it looks like you had a wonderful time. I would love to climb that tower. The views I am sure must have been amazing!

I was lucky enough to see the skyline of Moscow from this TV Tower and it is definitely mind-blowing.

hpi for well visit

Chelsea Pearl

Moscow is definitely up there on my travel bucket list. So much history and iconic architecture!

Thumbs up! 🙂

hpi for well visit

Blair Villanueva

OMG I dream to visit Moscow someday! Hope the visa processing would be okay (and become more affordable) so I could pursue my dream trip!

Yup, visa processing is the major downside! Agree! Time and the money consuming process…

Save my name, email, and website in this browser for the next time I comment.

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hpi for well visit

Best Places to visit in Moscow

Moscow is the capital city, as well as one of the, most visited tourist places in Russia . The city has a fascinating history and colorful, awe-inspiring architecture in the form of stunning cathedrals, churches, and palaces. The intricate detailing and complex architectural designs of the bygone era will surely keep anyone tranquilized. Red Square, St. Basil’s Cathedral, and Moscow’s Kremlin are the most prominent historical places to visit in Moscow. Besides, the city is also home to several museums where you can learn about Russia’s fantastic literary heritage, such as the Pushkin Memorial Museum, the Tolstoy House Museum, the Dostoevsky House Museum, and the Mayakovsky Museum. These places to see in Moscow are not just interesting but are beyond magical. Explore here, our list of best places to visit as part of Moscow Tour Packages .

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Red Square or Krasnaya Ploshchad is one of the largest and most impressive squares situated at the heart of the city of Moscow. Built-in the 1490s, the 73,000 square meters Red Square is separating the royal citadel of the Kremlin from the ancient merchant quarter of Kitai-gorod. It served as a gathering tourist place in Moscow, a marketplace, and a festival ground during the Soviet era. It is one of the most popular places to visit in Moscow due to its wealth of historical sights and cultural landmarks such as the Kremlin, St. Basil’s Cathedral, Lenin’s Mausoleum, and the State Historical Museum. Moscow’s Red Square along with the Kremlin was added to the UNESCO World Heritage Site list in 1990. Besides, wandering around the massive square is a humbling experience and undoubtedly one of the highlights the city has to offer as part of the Russia tour packages .

Bolshoi Theatre

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The Bolshoi Theatre is a historic theatre of ballet and opera situated at the Theatre Square in Moscow. With more than 200 dancers, it is one of the second-largest ballet and opera companies in Europe, and the main theater in Russia. This historic theatre was founded back in 1776, but the present magnificent building was built in 1825. Designed by architect Joseph Bove in classical Russian architectural style,  the building is all in white with 8 columns, intricate detailing on the facade, and the ‘quadriga’ adorned at the entrance. The six-tier auditorium is lavishly decorated and is a perfect setting for the world-class performances that take place on its stage. The performances here are mostly of Russian origins, with a few foreign performances also taking place. Spending a night watching a performance at the glittering Bolshoi Theatre is sure to be a memorable experience.

The Moscow Kremlin

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The Moscow Kremlin is a fortified complex located in the center of Moscow. Founded by the Rurik dynasty in the 15th century,  it was once the home of the Tsar family and is now the official residence of the president of the Russian Federation. Constructed beautifully and with a great eye for detail, the Moscow Kremlin complex covers an area of 275,000 square meters with 20 towers, 15 buildings, and more than 1.5 miles of walls that are made up to 21 feet thick. The intricate decor inside the Grand Kremlin Palace reflects the pure charm of the Revival architecture in Russian that blends perfectly with the architectural style of Byzantine Revival. The Cathedral Square is considered to be the center of the Kremlin complex and has three cathedrals of magnificent architecture. The complex is also home to several palaces and also the Ivan the Great Bell Tower. In the south is the Armoury building, a museum holding everything from the royal crown and imperial carriages to the ivory throne of Ivan the Terrible and Faberge eggs. Designated as a UNESCO World Heritage Site in 1990, it is undoubtedly one of the best Moscow tourist places.

St. Basil’s Cathedral

This image has an empty alt attribute; its file name is Moscow_Kremlin_Main-1.jpg

A trip to Moscow is incomplete without visiting this unique and impressive cathedral. Located in the impressive Red Square, St. Basil’s Cathedral is one of the top places to visit in Moscow and a popular cultural symbol of Russia. Also called ‘Pokrovsky Cathedral’, it was built in 1555 – 1561 by the order of Tsar Ivan the Terrible to celebrate his victory over the Khanate of Kazan. Built-in unique architecture inspired by Byzantine and Asian design, it is a magnificent work with 8 distinctive candy-colored onion domes. There are nine individual chapels inside the church, all decorated with colorful mural art. Today, St. Basil’s Cathedral serves as a museum, allowing visitors to see the simply breathtaking interiors and the intricacy of the work that was put into its construction.

The State Tretyakov Gallery

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The State Tretyakov Gallery is one of the most important and greatest art museums in Russia as well as in the world. Named after Pavel Tretyakov, a Moscow industrialist, and patron of art, the museum boasts the largest collection of Russian art in the world. A trip to this art gallery helps you to get a peek into the history of Russia and its evolution. The museum hosts an incredible collection that includes more than 190,000 paintings, icons, and sculptures of various eras and art traditions. The Tretyakov museum has two main buildings – one is on Lavrushinsky lane, where you can see the collections of Russian art from the 11th to 20th centuries, including famous masterpieces of Rublev, Repin, Serov, Vasnetsov, Surikov, Aivazovsky while the other building is on Krymsky Val which exhibits the collection of avant-garde, social realism, and other art trends of the 20th and 21st centuries.

State Historical Museum

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The State Historical Museum, located on the opposite end of Red Square, is one of the largest museums in Russia, and among the must-visit Moscow tourist places. This amazing museum was constructed in 1872 by the orders of Emperor Alexander II to commemorate national history and educate the masses about the long past of the country. This imposing Russian Revivalism style building houses an enormous collection of objects reaching the 5 million figure. Ranging from the days of the pre-historic tribes of the region to the Russia of today, the collection includes several relics, artifacts, paintings, thrones, etc.

The Moscow Planetarium

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The Moscow planetarium is one of the oldest planetariums in Russia and among the best places to visit in Moscow. It is one of the favorite places for recreation, with all kinds of interactive exhibits, educational programs, entertainment, high-tech gadgetry, and scientific components. Inaugurated in 1929, it was built by the architects Mikhail Barsh, Mikhail Sinyavsky, and engineer Georgy Zunblat. The main highlight of the museum is the Large Star Hall which boasts Europe’s largest star projection dome with its 25-silver dome roof that features glowing northern lights, floating clouds, August meteor showers, flickering stars, flying comets, and solar eclipses. Attracting thousands of visitors, it is one of the biggest destinations on the Moscow Museum circuit.

Ostankino Television Tower

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Ostankino Television Tower is the most famous television and radio tower located in Moscow. Designed by Nikolai Nikitin. it was built in 1967 to mark the 50th anniversary of the October Revolution, and named after the Ostankino district of Moscow. Towering 1,772 feet, it is the eleventh high-rising structure in the world and the only free-standing structure in the whole of Europe. Also, don’t miss to visit the glass-floored observation deck located at a height of 1,105 feet (337 feet) from where one can get incredible views of Moscow city.

Museum of Cosmonautics

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Located in the northeast of Moscow city, the museum of Cosmonautics is one of the best museums in Russia dedicated to space exploration. This museum is a must-visit place for those who want to know everything about space adventure as the Museum of Cosmonautics traces the history of astronautics from the 1920s to the present day. The museum consists of more than 98,000 artifacts including historical documents, spacesuits, an authentic spacecraft, personal belongings of astronauts, and even the replica of the space station “Mir”. Furthermore, it is also known for its rich collection and brilliant architecture.

The Pushkin State Museum of Fine Arts

hpi for well visit

Located in the center of Moscow, the Pushkin Museum is one of the most famous museums in Russia. The museum was opened in 1912 amid Emperor Alexander III’s rule and was renamed the Pushkin Museum in 1937, in honor of the celebrated Russian writer, Alexander Pushkin. The museum houses the largest collections of foreign art in Russia, showcasing global artistic developments from ancient times to the present day. Currently, the museum houses around 700,000 paintings, sculptures, drawings, applied works, photographs, and archaeological and animalistic objects. Some of the exhibits date back to Ancient Egypt and antiquity while others are modern demonstrating the more recent artistic and cultural trends. The museum houses the second-largest collection of world art in Russia after the Hermitage Museum in St. Petersburg. One of the greatest masterpieces of the museum is the actual main building itself which reflects the architectural traditions of the antique Greek temples.

Grand Kremlin Palace

hpi for well visit

Built-in 1849 atop Borovitsky Hill, the Grand Kremlin is a lavishly decorated palace that is closely associated with the wealth and splendor of the Russian emperors who lived here a long time ago. Designed by Konstantin Thon, the palace reflects the pure charm of Russian architecture that stands 125 meters long, 47 meters high, and total area of around 25,000 sq. m. Made of gold, marble and intricate designs, the main highlight of the palace is the Holy Vestibule, the nine churches, Palace of Facets for celebrations and glimpses of majestic imperial thrones, Tsarina’s Golden Chamber, the place of Russian Queen, five grand reception halls and over 700 rooms and apartments. The Grand Kremlin Palace was once home to the Tsar family and is now the official residence of the president of the Russian Federation, although most heads of state choose to reside elsewhere.

Arbat Street

hpi for well visit

Surrounded by historical buildings, the Arbat Street is one of the oldest streets in Moscow and among the best Moscow tourist places. With 1.25 km long, this 15th century lively street was once a popular place to live for the novelty families, merchants, poets, artists, and academics. The street has been decorated with distinctively beautiful street lantern on weekends and evenings that add more charm to this place. Today, the street is filled with several restaurants, cafes, shops, as well as many statues and monuments. Besides, it is also one of the best places for shopping in Moscow that attracts huge number of tourists as part of Moscow Tour Packages.

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  1. Combining a Wellness Visit With a Problem-Oriented Visit: a Coding

    hpi for well visit

  2. Tips For A Better HPI

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  3. NEW! Promoting the Well-Visit to Parents

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  4. Importance of Well Child Visits During COVID-19

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  5. HPI New Patient

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  6. Sample Hpi For Annual Physical Exam

    hpi for well visit

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COMMENTS

  1. HPI Template: General/Well exam

    A well exam is usually a yearly exam for your checkups. Can be called annual exam, well exam, general medical exam, etc. Typically when you are a pediatric patient, you have many well exams in a year. For example, you will be seen at 1 week post-life, then like 1 month, 2 months, 4 months, 6 months, etc. Once you reach about the age of 2 or 3 ...

  2. PDF B. Guide to the Comprehensive Adult H&P Write‐Up

    Assess the patient's functional status - ability to complete the activities of daily living. Consider documentation of any important life experience such as military service, religious affiliation and spiritual beliefs. Review of Systems. Include patient's Yes or No responses to all questions asked by system.

  3. Combining a Wellness Visit With a Problem-Oriented Visit: a ...

    Bill 99213 (or 99203 for new patients) with preventive or wellness code. An acute, uncomplicated illness at time of visit. An active, stable medical problem. Two minor problems. Remember to ...

  4. PDF Annual Wellness Visit Guide

    Use this guide to assist with documentation of the Annual Wellness Visit in the patient chart.

  5. PDF ANNUAL WELLNESS VISIT

    What is the Annual Wellness Visit? Medicare's Annual Wellness Visit (AWV) is not a typical physical exam, rather it is an opportunity for patients and providers to: • Focus on specific issues important to older adults • Consider issues that may be overlooked in a typical physical exam

  6. Get Paid with the Annual Wellness Visit

    Optimize revenue and improve patient outcomes with Medicare's Annual Wellness Visits. These visits help you identify care gaps, increase revenue, and prepare your practice for value-based care ...

  7. PDF Guide to the Comprehensive Pediatric H&P Write Up

    here such as last dental visit, last ophthalmology visit… A. General: Unusual weight gain or loss, fatigue, temperature sensitivity, mentality. Pattern of growth (record previous heights and weights on appropriate graphs). Time and pattern of pubescence. B. Eyes: Have the child's eyes ever been crossed?

  8. How to properly document wellness visits and physicals

    This needs to be clearly explained to the patient beginning with the appointment phone call. An AWV (G0438/G0439), preventive physical (99381-99387) and an evaluation and management (E/M) service (99201-99215) can all be billed on the same date. However, your documentation must support each of these services. For the initial or subsequent AWV ...

  9. MLN6775421

    Initial Preventive Physical Exam. The initial preventive physical exam (IPPE), also known as the "Welcome to Medicare" preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it's provided within the first 12 months after the patient's Part B coverage starts. IPPE Components.

  10. PDF Adolescent Wellness Exam: Overcoming Reluctance on Both Sides by ...

    delivering preventive services to patients in the context of a clinical visit. Information presented is based on evidence presented in peer-reviewed journals. Please refer to the Adolescent Wellness Exam Clinical Reference for more information. Adolescent Wellness Exam Adolescence is thought of as the healthiest stage of life.

  11. Well Child Check Visit Notes

    Well Child Check Visit Notes From Ventura Family Medicine Residency. NEWBORN WT/COLOR CHECK 2 WEEKS 6-8 WEEKS 4 MONTHS 6 MONTHS 9 MONTHS ONE YEAR 15 MONTHS 18 MONTHS 2 YEARS 3 YEARS 4 YEARS 5 YEARS 6 YEARS 7 YEARS 8-11 YEARS ADOLESCENT (12 yrs and older) NEWBORN WT/COLOR CHECK 2 WEEKS 6-8 WEEKS 4 MONTHS 6 MONTHS 9 MONTHS ONE YEAR 15 MONTHS

  12. Annual Wellness Visit Coverage

    for longer than 12 months, you can get a yearly "Wellness" visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly "Wellness" visit isn't a physical exam. Your first yearly "Wellness" visit can't take place within 12 months of your Part B ...

  13. PDF Pediatric H&P CC: HPI

    HPI: The patient was acting totally normal and healthy until they developed some congestion and a fever yesterday. The fever initially was controlled with Tylenol until the middle of last night when the temperature remained at 103oF despite a Tylenol dose.

  14. Well-Woman Chart

    Preventive care visits provide an excellent opportunity for well-woman care including screening, evaluation of health risks and needs, counseling, and immunizations. Recommendations for Well-Woman Care - A Well-Woman Chart was developed by the Women's Preventive Services Initiative (WPSI).

  15. Well-Woman Visit

    ABSTRACT: A well-woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks. Given the shifting and complex landscape of care, in which many women may not receive all the recommended preventive services, obstetrician-gynecologists have an opportunity to contribute to the overall health and well-being of women throughout ...

  16. PDF Accessing and Using Well Child Check Templates

    To get to a templated physical exam for well child visits, click One Page Exam. When the template opens, click the starburst icon; choose the WCC exam. Edit the template as needed. Review the documented exam after you close the template to make sure it looks as you intended.

  17. The Adult Well-Male Examination

    In 2007, men 15 to 65 years of age were significantly less likely than women to seek preventive care services from a primary care physician (15% vs. 44% of total visits, respectively). 3 In 2000 ...

  18. PDF Initial visit H&P

    ROS: Constitutional- as above Skin- No rashes, pruritis, or jaundice. Head- No headaches or dizziness Eyes- No vision changes or pain Ears- No tinnitus or changes in hearing Nose- Some recent congestion and rhinitis. No epistaxis. Mouth/Throat- So throat soreness and dryness. No oral sores or dysphagia.

  19. What Worries Me About War With China After My Visit to Taiwan

    He described it as an update of the strategy for how to win without fighting a battle depicted by the ancient Chinese military strategist Sun Tzu in "The Art of War.". "The threat is not ...

  20. Is Matthew Wong the 21st Century's van Gogh?

    The MFA Boston's Matthew Wong retrospective, "The Realm of Appearances," is closing soon and well worth a visit. By Katherine Schreiber • 02/02/24 3:45pm.

  21. 'Sexualized' Jesus: controversy in Spain over poster of Christ for

    A controversy has ensued in Spain over an artwork created for Easter week in Seville, with some seeing the image of Jesus created by artist Salustiano García as sexualized and offensive, which ...

  22. Things to do in Moscow: how to visit Moscow

    Visit Kremlin is on top of things to do in Moscow. A place of power for centuries, the Kremlin then shows us a whole different image when viewed from the inside. If you want to visit Moscow in 2 days, the Kremlin is certainly one of the must-see places in Moscow. Opening hours: Daily from 10 a.m. to 5 p.m., except Thursday.

  23. It's so cold and snowy in Alaska that fuel oil is thickening and roofs

    The roof of a building is partially collapsed by snow, early on Tuesday in Anchorage, Alaska. Loren Holmes / Anchorage Daily News via AP. A man believed to have fled a fire at a home in the south ...

  24. Elmo's wellness check uncovers existential dread and despair on social

    Elmo learned that it is important to ask a friend how they are doing," he wrote in a follow-up post. "Elmo will check in again soon, friends! Elmo loves you. ️ #EmotionalWellBeing". Some ...

  25. how to write an HPI

    Ah. So glad you asked. A well exam is usually a yearly exam for your checkups. Can be called annual exam, well exam, general medical exam, etc. Typically when you are a pediatric patient, you have many well exams in a year. For example, you will be seen at 1 week post-life, then like 1 month, 2 months, 4 months, 6 months, etc.

  26. Travel Itinerary For One Week in Moscow

    And when you visit you'll quickly realize why locals love this park. Like many other estates, Kuskovo has just been renovated. So there are lovely French formal garden, a grotto, and the Dutch house to explore. Make sure to plan your itinerary well because the estate is some way from a metro station. Day 6 - Explore the Golden Ring

  27. Trump: Stock market thriving because 'they think I'm going to be

    02/01/24 2:06 PM ET. Former President Trump said the stock market is doing well because investors are confident he'll be elected again in 2024. "So I mean, the Biden team can say, well, if ...

  28. A conservative case for normalization with Cuba

    A conservative case for normalization with Cuba. by Benjamin R. Young, opinion contributor - 02/02/24 2:00 PM ET. Leandro Rodriguez, 69, carries a package of food donated by several countries ...

  29. Best Places to visit in Moscow

    Best Places to visit in Moscow. December 6, 2022 Kshama Bhavani. Moscow is the capital city, as well as one of the, most visited tourist places in Russia. The city has a fascinating history and colorful, awe-inspiring architecture in the form of stunning cathedrals, churches, and palaces. The intricate detailing and complex architectural ...