Childhood Screening Web Attestation

Welcome to MHS Health Wisconsin. We thank you for being part of our network of participating physicians, hospitals and other healthcare professionals.

Please provide any additional TINs that should be represented on this form.

Does your TIN serve pediatric patients *
I attest that the above TIN(s) is following the Recommendations for Preventive Pediatric Health Care as indicated in the most recent Bright Futures-AAP Periodicity Schedule (link below) *
I attest that the above TIN(s) is using the Instruments for Recommended Universal Screening at Specific Bright Futures Visits as listed in the most recent Bright Futures Toolkit (link below) *