Prevention Assignment Template and Grade SheetPrevention DxRisk Profile:Age/Gender/Race risks-BRCA-related cancer, Breast cancer, cervical cancer, chlamydiaand gonorrhea, colorectal cancer, depression, healthy diet andphysical activity for cardiovascular disease prevention in adultswith cardiovascular risk, hepatitis B, Hepatitis C, HIV,Hypertension, Latent tuberculosis infection, lung cancer,osteoporosis to prevent fractures, pre-diabetes and type IIdiabetes, STDs, Statin use for the primary prevention ofcardiovascular disease in adults, syphilis infection in non-pregnant adults, tobacco smoking and cessation in adults,unhealthy alcohol use in adults, unhealthy drug use, weight lossto prevent obesity-related morbidity and mortality in adults.Personal/Family risks-Osteopenia, Osteoporosis (due to osteopenia and patient is onHRT), Blood clots (due to HRT), STDs (due to being sexuallyactive), depression (due to sadness), lung cancer (due tosmoking), CVD (due to smoking), Vaccine preventable disease,Obesity, ETOH use disorderHypertension, hyperlipidemia, COPD, cerebrovascular accidentPrevention Needs:Screening Needs:BRCA gene testing for BRCA related cancer and breast cancer;Pap smear for cervical cancer; urine or vaginal secretions for GCand Chlamydia; Colonoscopy for colorectal cancer; Geriatricdepression scale; Hepatitis B surface antigen and surfaceantibody; HCV antibody test; HIV by ELISA; BP check and homemonitoring for hypertension; TB testing; sputum cytology for lungcancer; DEXA scan for osteopenia and osteoporosis; HemoglobinA1c and fasting plasma glucose; Bacterial vaginosis andtrichomoniasis swab testing; Lipid panel; Syphilis blood test;check D-dimer and ultrasound for blood clots; X-ray/CT scan,;Echocardiogram, ECG, or stress test for CVD; Pulmonary functiontests and chest x-ray for COPD; Obesity screening; CAGEquestionnaire or AUDIT assessment screening for alcohol use;Varicella titer if cannot recall chickenpox; and MRI for CVA.
