(928) 779-2113
7/1/2009
EPSDT Tracking Forms
The AHCCCS EPSDT Tracking form, Revised November 1, 2007, must be used by providers to document all age specific, required information related to EPSDT screenings and visits. Only the AHCCCS forms may be used; paper form substitutes are not acceptable. If Provider chooses to utilize an electronic EPSDT form, this electronic substitute will be acceptable provided the form includes all fields that are present on the AHCCCS EPSDT form. A copy of the completed form signed by the clinician should be placed in the Member’s medical record.
