What components should be included in a comprehensive wellness visit for a 17‑year‑old female adolescent?

Comprehensive Wellness Visit for a 17-Year-Old Female

A wellness visit for a 17-year-old female must include mandatory confidential time alone with the adolescent for psychosocial screening, comprehensive physical examination with vital signs and Tanner staging, immunization review and administration, STI and pregnancy screening if sexually active, and extensive anticipatory guidance covering safety, sexual health, mental health, substance use, and nutrition. 1, 2, 3

Structure and Confidentiality Requirements

Initial Assessment with Parent/Guardian Present

• Review complete medical history, current medications, and family health history 1, 2
• Document growth parameters (height, weight, BMI) and plot on growth charts 1
• Assess pubertal development using Tanner staging 1, 2
• Review school performance, sleep patterns (should be 8-10 hours nightly), and dietary habits 1, 3
• Document screen time and physical activity levels 1

Mandatory Private Confidential Time

• Approximately 58% of high school students report health concerns they want to keep private from parents, making confidential time the single most critical element for addressing preventable causes of adolescent morbidity and mortality. 4, 2
• Explain confidentiality limits upfront: you will maintain privacy except for imminent harm to self or others, or abuse 3
• This private time is when you address substance use, sexual activity, mental health, and violence—topics that directly impact survival in this age group 2, 3

Comprehensive Psychosocial Screening (During Private Time)

Mental Health Assessment

• Screen annually for depression, anxiety, suicidal ideation, and self-harm using validated tools—suicide is a leading cause of death in adolescents, and 80% of those needing mental health treatment are not receiving it. 2, 3
• Assess for eating disorders and body image concerns using validated screening tools 2
• Evaluate peer relationships, social functioning, and signs of social isolation 2, 3

Substance Use Screening

• Use the CRAFFT questionnaire to screen for alcohol, marijuana, tobacco/nicotine (including e-cigarettes and vaping), and other drug use 2, 3
• Substance abuse is a leading cause of adolescent morbidity and mortality, making this screening non-negotiable 2, 3

Sexual Health and Relationship Assessment

• Screen for sexual activity, number of partners, contraception use, and history of STIs 2, 3
• Discuss consent, healthy relationships, and prevention of STIs and unintended pregnancy 2, 3
• Screen for sexual violence, dating violence, and non-consensual sexual encounters—approximately 11% of young adults report unwanted first sexual experiences 2
• Provide comprehensive education on the full spectrum of contraceptive methods: barrier devices, hormonal options, long-acting reversible contraception (IUDs and implants), and emergency contraception 3, 5
• Initiate preconception counseling at this age, including discussion of folic acid supplementation (400-800 mcg daily) for all females of reproductive age to reduce neural tube defect risk. 3, 5

Violence and Safety Screening

• Screen for involvement in or victimization from physical, sexual, or emotional violence 2, 3
• Assess for bullying, weapons exposure, and signs of physical or emotional abuse 2, 3

Physical Examination

Vital Signs and Measurements

• Measure blood pressure annually using proper technique with age-appropriate cuff size 2, 3
• If blood pressure is elevated (≥90th percentile), recommend lifestyle interventions and recheck in 6 months 1, 2
• Document height, weight, and calculate BMI with percentile ranking 1

Complete Physical Examination

• Perform comprehensive examination including cardiovascular, respiratory, abdominal, skin, and musculoskeletal assessment 2, 3
• Conduct genitourinary examination as clinically indicated 2, 3
• Assess for signs of physical abuse or neglect 1, 2
• Complete Tanner staging for pubertal development 1, 2

Laboratory Screening and Testing

Routine Screening

• Lipid panel if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11 2, 3
• Hemoglobin/hematocrit screening 2

STI Screening for Sexually Active Adolescents

• Screen annually for gonorrhea, chlamydia, and HIV in all sexually active adolescents. 2, 3, 5
• Consider syphilis and hepatitis B screening based on risk factors 5
• Perform urine pregnancy test if sexually active 5

Immunizations

Required Vaccines at Age 17

• Tdap booster if not previously given at age 11-12 2, 3
• HPV vaccine series (if not completed)—give a strong recommendation emphasizing cancer prevention and normalize by coadministering with other vaccines 2, 3
• Meningococcal conjugate vaccine (MenACWY) 2
• Annual influenza vaccine 2, 3
• Review and catch up any missed childhood vaccinations 2, 3

Anticipatory Guidance and Health Promotion

Injury Prevention and Safety

• Emphasize seatbelt use, dangers of distracted and impaired driving, and helmet use for sports and cycling—unintentional injuries are the leading cause of adolescent death. 1, 2, 3
• Discuss firearm safety, including safe storage and restricted access 2
• Address risks of driving with multiple passengers and graduated licensing laws 2

Nutrition and Physical Activity

• Recommend at least 60 minutes of moderate to vigorous physical activity daily, including resistance and flexibility training 1, 2
• Discuss healthy eating patterns, limiting sugar-sweetened beverages, and appropriate portion sizes 1, 2, 3
• Address calcium and vitamin D intake for bone health 5

Sleep and Screen Time

• Assess sleep patterns and recommend 8-10 hours of sleep nightly 3
• Counsel on limiting screen time before bedtime to improve sleep quality 3

Substance Use Prevention

• Strongly discourage all forms of tobacco and nicotine use, including cigarettes, e-cigarettes, and vaping. 3
• Discuss risks of alcohol consumption and strategies to minimize harm 3
• Advise against recreational cannabis use in any form 3

Sexual and Reproductive Health Education

• Provide thorough education on consent, healthy relationships, and communication skills 2, 3
• Discuss confidential access to sexual and reproductive health services, including emergency contraception 2
• Counsel about media portrayals of sexuality and risks of social media interactions and sexting 2

Critical Pitfalls to Avoid

Do Not Conduct Brief "Sports Physicals"

• Station-based sports physicals lack psychosocial screening, confidentiality, and comprehensive assessment—they miss opportunities for early diagnosis and treatment of conditions causing significant morbidity and mortality in adolescents. 1, 2, 3
• These examinations focus only on orthopedic fitness and fail to address mental health, substance use, sexual health, and other critical preventable causes of death 2

Never Skip Confidential Time

• Failing to provide private time alone with the adolescent results in missed screening opportunities for risky behaviors that directly cause adolescent deaths 2, 3
• Almost 1 in 4 adolescent females report being too embarrassed to discuss important health issues when parents are present 2

Do Not Defer or Weaken HPV Vaccination Recommendation

• Give a strong, unequivocal recommendation for HPV vaccination emphasizing cancer prevention 2, 3
• Normalize the vaccine by coadministering it with other routine vaccines 2

Never Omit Depression Screening

• Annual depression screening is mandatory starting at age 11 and must continue through age 21 2, 3
• This is non-negotiable given that suicide is a leading cause of adolescent death and most affected youth are not receiving treatment 2, 3