Health assessment guidelines (Medi-Cal)

Initial Health Assessment

Completing a timely Initial Health Assessment (IHA) provides an opportunity for members to establish a relationship with their PCP. The assessment allows members to obtain necessary health care and preventive services, which can lead to positive health outcomes and improvement in their overall health status. All newly enrolled members must receive an Initial Health Assessment (IHA) within 120 days of enrollment (DHCS Policy Letter 08-003). A minimum of three documented attempts must be made to schedule the IHA, including at least one phone call and one letter.

The IHA consists of but is not limited to:

  • A comprehensive health history (medical, social, family) 
  • Physical exam, including a systems review
  • The completion of the Staying Healthy Assessment
  • Immunizations 
  • Counseling, including Tobacco Cessation
  • Medical testing and treatment
  • Blood lead level 

IHA resources


Although there is no specific form, you must complete documentation of this visit for the patient’s medical record. You must document provision of the assessment or a comparable comprehensive assessment in the patient's medical chart. You may use age-appropriate physical evaluation templates (PDF, 133 KB).

During their Initial Health Assessment, members need to complete an Individual Health Education Behavioral Assessment Tool (IHEBA) in their age category. The IHEBA can help you identify risky health behavior in order to promote positive lifestyle changes. Forms are available for download below.

In our efforts to coordinate with our providers, Blue Shield Promise conducts outreach to all new members to ensure timely IHA access. Within 120 days of enrollment, members receive phone calls and letters notifying them of this service and encouraging them to call their PCP to make an IHA appointment. Blue Shield Promise also sends a letter to the PCPs notifying them of their newly assigned members and reminding them of the requirement to conduct a timely IHA. We will follow up with the PCP to verify whether member outreach was conducted, or an effective follow-up was done.

Please be advised your office may be randomly selected to participate in the IHA Medical Record Review utilizing the IHA Audit Tool (PDF, 272 KB)

On a monthly basis, Blue Shield Promise and your contracted Medical Group/IPA sends contracted PCPs a list of new members who are due for an IHA. There are multiple ways to receive this information, such as a secure document exchange site, website portal, via secure email, or mail. Please contact your contracted Medical Group/IPA for assistance or call our Blue Shield of California Promise Health Plan Provider Services number (PDF, 129 KB).

Staying Healthy Assessment

DHCS had released the Staying Healthy Assessment guidelines via Policy Letter 13-001, "Requirements for the Staying Healthy Assessment (PDF, 204 KB)”. For implementation and documentation requirements, please view or download the following provider training presentations. DHCS expects 100% participation from all provider offices.

SHA training:

 DHCS SHA provider training

SHA resources:

 SHA Instruction Sheet for Provider Office (PDF, 60 KB)
 Electronic SHA Format Notification Form (PDF, 150 KB)
 Preventive Health Guidelines (PDF, 230 KB)
 Preventive Health Guidelines - Spanish (PDF, 163 KB)

Staying Healthy Assessment forms

Provider manuals

Review and download provider manuals for Cal MediConnect and Medi-Cal policies.

Access to care standards

Learn the guidelines Blue Shield of California Promise Health Plan uses to ensure our members have proper access to care.

Nursing Facilities Reference Guide

Learn about the requirements for Blue Shield Promise's provider network nursing facilities.

Physician’s facility site review policy and procedures

See policies for site accessibility, fire safety and prevention, non-medical emergency procedures, medical equipment maintenance, and staff qualification requirements.

Medical record documentation standards

Learn about the requirements and standards for Blue Shield Promise member medical records.

Provider dispute resolution policy and procedures

Communicate your questions and concerns to Blue Shield Promise and learn how to appeal or dispute a claim payment.

Fraud prevention guidelines

Learn how to report suspected healthcare fraud and find prevention tips and guidelines.


Find the forms you need for authorizations, referrals, service requests, EFT enrollment, and provider disputes.

醫療保健方案處:1-844-580-7272,週一至週五上午8點至下午6點。 聽障和語障用戶應致電1-800-430-7077。

有關 Blue Shield Promise Cal MediConnect Plan和您的醫療保健的其他 Cal MediConnect選項的資訊,請致電醫療保健服務部1-800-430-4263(聽障和語障專線:1-800-735-2922)或訪問

Blue Shield of California Promise Health Plan是一家管理式護理組織,由Blue Shield of California全資擁有,提供Medi-Cal和Cal MediConnect 計劃。

© 2002-2023. 年California Physicians’ Service DBA Blue Shield of California Promise Health Plan版權所有。保留所有權利。

California Physicians’ Service DBA Blue Shield of California Promise Health Plan是Blue Shield Association的獨立持照者。


Blue Shield of California Promise Health Plan遵守相關的州和聯邦民權法律規定,不會因為種族、膚色、民族起源、祖先、宗教、性別、婚姻狀態、性別認同、性傾向、年齡或殘障而歧視任何人。

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan 遵循適用的州法律和聯邦公民權利法律,並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。



Blue Shield of California Promise Health Plan, 601 Potrero Grande Drive, Monterey Park, CA 91755。

Apple 和 Apple標誌是Apple Inc.的商標。App Store是Apple Inc.的服務標誌。

Google Play和Google Play標誌是Google LLC的商標。