Oklahoma's SoonerCare program publishes sixteen age-specific templates for documenting EPSDT well-child visits, from the week-old visit (CH-1) through the 11 to 20 year old visit (CH-16). Each two-page form walks through history, sensory screening, physical exam, developmental assessment, anticipatory guidance, procedures and immunizations due. Practices use them as optional documentation kept in the child's medical record.
The pediatric or primary care clinician performing the visit completes the form and signs it with the date. A patient sticker can be used for the identifying details.
Download the current version from the source each time; forms change without notice.
SoonerCare EPSDT Child Health Visit Forms (Week Old Visit through 11 to 20 Year Old Visit)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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They are optional OHCA templates. Practices can use them to document each age-specific well-child visit and keep the completed form in the child's medical record. The templates cover the visit components, from history and screening through anticipatory guidance, immunizations and the next visit due date.
CH-16 covers the 11 to 20 year old visit, and CH-15 covers ages 6 to 10. Alongside the visit series, the OHCA forms page lists CH-17, a psychosocial assessment available in English and Spanish, and CH-18, a 5As tobacco cessation counseling form.