Comprehensive Annual Exam Guidelines

Patient Assessment and Examination

A comprehensive annual exam should include a complete medical history, physical examination, appropriate screening tests, and preventive counseling tailored to the patient's age, gender, and risk factors, with a directed review of systems, including vital signs (blood pressure, height, weight, BMI), head and neck examination, visual acuity testing, visual fields assessment, external eye examination, pupillary function assessment, ocular alignment and motility testing, slit-lamp biomicroscopic examination, intraocular pressure measurement, and fundus examination, as recommended by the American Academy of Ophthalmology 1, 2
The exam should assess visual function and symptoms, as recommended by the American Academy of Ophthalmology 1

Blood pressure screening should be performed at least every 2 years for all adults, according to the American Heart Association 1
Cholesterol screening should be based on cardiovascular risk assessment, as recommended by the American College of Cardiology 1
Diabetes screening should be performed using fasting glucose or HbA1c for those with risk factors, according to the American Diabetes Association 1
Cancer screenings are recommended, including:
Depression screening should be performed using validated tools, as recommended by the American Psychiatric Association 1
STI screening should be based on sexual history and risk factors, according to the Centers for Disease Control and Prevention 1, 3, 4, 5

Preventive counseling should include tobacco cessation, alcohol and substance use, diet and nutrition, physical activity, sexual health and contraception, injury prevention, mental health, sleep hygiene, and dental care, as recommended by the American Academy of Family Physicians 5
Patient expectations and mental health should be actively addressed, using validated tools for depression and anxiety screening, as recommended by the American Psychiatric Association 5
Patient-specific risk factors and social determinants of health should be assessed and addressed during the visit, according to the American Academy of Family Physicians 5

Patients with diabetes should have annual examinations, according to the American Diabetes Association 1
African Americans and Hispanics should have more frequent examinations due to increased glaucoma risk, as recommended by the American Academy of Ophthalmology 1
Individuals with a family history of certain cancers should have more frequent targeted screenings, according to the American Cancer Society 1
The frequency of comprehensive annual exams should be:

The American College of Physicians states that evidence does not support comprehensive annual physical examinations for all asymptomatic adults 1
The US Preventive Services Task Force recommends connecting patients to recommended preventive services and early detection of health issues 1
Overscreening should be avoided, and evidence-based guidelines for screening intervals should be followed, according to the American College of Physicians 1