EPSDT / HCY Required Forms
Healthy Children & Youth Screenings

Click here for an overview of EPSDT.

Newborn - 1 Month	12-14 Months	4 Years	12 - 13 Years
2-3 Months	15-17 Months	5 Years	14-15 Years
4-5 Months	18-23 Months	6-7 Years	16-17 Years
6-8 Months	24-35 Months	8-9 Years	18-19 Years
9-11 Months	3 Years	10-11 Years	20 Years

EPSDT / HCY Required Forms
Use & Interpretation

Growth Charts

Birth-36 Months: Length-for-age and Weight-for-age percentiles	Boys	Girls
Birth-36 Months: Head circumference-for-age and Weight-for-length percentiles	Boys	Girls
Weight-for-stature percentiles	Boys	Girls
2-20 yrs: Stature-for-age & Weight-for-age percentiles	Boys	Girls
2-20 yrs: Body mass index-for-age percentiles	Boys	Girls

Missed Appointments

• Instructions
• Missed Appointment Notification Form
• Missed Well-Child Visit (children)
• Missed Well-Care Visit (teens)

Additional Resources

• Health Education Literature List
• Order information for EPSDT forms
• MO HealthNet Forms Request
• EPSDT website links