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Preventive Care Toolkit Order Form

Ready to order? Follow the instructions below to begin the order process:

Check the selection box in front of the description
Fill in the corresponding quantity
Choose either:
- Cancel Order—to stop the selection process and return to the provider home page
- Complete Your Order—to submit your order

Note: Using your browser Back button will cancel your order.

Preventive Care Toolkit Description:	Form # :	Date:
Adult Health Maintenance Guidelines details	M-13211	3/04
Adult Health Maintenance Flow Chart details	M-13215	7/04
Adult Body Mass Index (BMI) Table details	M-2081	4/04
Adult Prevention/Screening (My Prescription for You) details	M-53762	10/04
Adult Lifestyle Change (My Prescription for You) details	M-53764	10/04
Adolescent Health (My Prescription for You) details	M-53763	10/04
Problem List/Past Medical History details	S-2600	10/01
Tips to Help You Quit Fact Sheet details	M-23151	11/04
10 Tips for Reaching Physical Activity Goals Fact Sheet details	M-23150	11/04
Follow a Healthy Eating Plan Fact Sheet details	M-23149	11/04
Simple Ways To Make Everyday Choices for a Healthier Life Fact Sheet details	M-23148	11/04
Step Up to Better Health - Start Walking Brochure details	M-23115	8/04
Walking Works^SM Activity Tracker details	M-20109	12/04

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