Annual Wellness Visit Components for General Adults
An annual wellness visit should include structured health risk assessment, vital signs and anthropometric measurements, age-appropriate cancer and cardiovascular screening, cognitive and mental health evaluation, and personalized prevention planning with lifestyle counseling—not a traditional comprehensive physical examination. 1
Core Assessment Components
Health Risk Assessment and Vital Measurements
- Complete a standardized Health Risk Assessment questionnaire covering medical history, family history, current medications, lifestyle factors, and social determinants of health 1
- Measure height, weight, calculate BMI, and obtain blood pressure at every visit 1
- Review and reconcile all current medications, assessing for medication-taking behavior, potential rationing, intolerance, and side effects 2
Cognitive and Mental Health Screening
- Screen for cognitive impairment using brief structured tools such as Mini-Cog (76% sensitivity, 89% specificity), General Practitioner Assessment of Cognition, or Memory Impairment Screen 1, 2
- Perform depression screening using validated instruments like PHQ-2 or PHQ-9 1, 2
- Screen for anxiety using validated tools when appropriate 1
Common pitfall: Do not skip cognitive screening even if the patient appears cognitally intact—Medicare specifically requires this assessment and early detection facilitates planning 1
Functional Assessment
- Evaluate activities of daily living and mobility status, particularly critical for patients ≥65 years 1, 2
- Assess functional performance to identify geriatric syndromes 1
Laboratory and Preventive Screening
Cardiovascular Risk Assessment
- Order complete blood count with differential and comprehensive metabolic panel 1
- Check fasting lipid profile (total cholesterol, LDL, HDL, triglycerides) if not done within the past year 1, 2
- Screen for diabetes with A1C testing if not available within past 3 months 2
Cancer Screening
- Initiate or update colorectal cancer screening beginning at age 45 (not age 50—guidelines have recently lowered the starting age) 1
- For women: perform cervical cancer screening with Pap smear every 3 years, or for ages 30-65, cytology plus HPV testing every 5 years 2
- For women: clinical breast examination annually for ages >19 years, and mammography biennially for ages 50-74 years 2
- For men: discuss prostate cancer screening using shared decision-making 1
Common pitfall: Do not delay colorectal cancer screening beyond age 45, as this represents updated guidance from the previous age 50 recommendation 1
Immunizations
- Review and update vaccination status according to age-appropriate CDC recommendations 1
- Administer annual influenza vaccine 1
- Provide pneumococcal vaccination (PPSV23) for patients ages 2-64 years with diabetes or other high-risk conditions 1
Behavioral and Social Assessment
Lifestyle Factors
- Screen for tobacco, alcohol, and substance use with appropriate counseling 2
- Assess physical activity levels and sleep behaviors, including screening for obstructive sleep apnea 2
- Evaluate eating patterns and weight history 2
Social Determinants of Health
- Assess food security, housing stability, transportation access, financial security, and community safety 2
- These factors significantly impact health outcomes and adherence to treatment plans 2
Prevention Planning and Counseling
Lifestyle Modification Counseling
- Provide counseling on diet emphasizing fruits, vegetables, and low-fat dairy products 1
- Recommend physical activity—adults should engage in regular moderate-to-vigorous activity 3, 4
- Address tobacco cessation and alcohol use 1
- Discuss sleep patterns and duration 1
Evidence context: While traditional annual physical examinations lack empirical evidence of value, targeted preventive health encounters focusing on age/gender/risk-appropriate screening and counseling contribute meaningfully to health goals 3. The opportunistic model of prevention during illness visits results in disappointing and erratic adherence to guidelines 3
Advance Care Planning
- Identify surrogate decision maker and discuss advance care planning 1
- Address healthcare proxy, living will, and end-of-life preferences 1
Personalized Prevention Plan
- Develop individualized prevention plan based on identified risk factors and health needs 2
- Make referrals to health education, prevention counseling services, or diabetes care and education specialists as needed 2
Clinical Outcomes Evidence
Wellness visits identify previously unrecognized diagnoses: On average, 0.4 new diagnoses are identified per wellness visit, including cancer diagnoses, cardiovascular risks, and infections 5. Patients average 6.9-7.7 clinical preventive service discussions per visit 5.
Disease detection and control improve: General health checks increase detection of chronic diseases like depression and hypertension, moderately improve controlling risk factors like blood pressure and cholesterol, and increase clinical preventive service uptake such as colorectal and cervical cancer screening 6. However, they are not associated with reduced mortality or cardiovascular events 6.
Lifestyle interventions produce measurable benefits: Comprehensive lifestyle modification programs result in significant improvements including mean weight reduction of 6.8 kg, waist circumference reduction of 6.1 cm, and improvements in glucose, triglycerides, LDL cholesterol, HgbA1c, insulin, and C-reactive protein at 6 months 7