UCLA 20-Minute Medical Exam
General Office Forms
Physicians are unable to provide high quality of care for conditions affecting older persons
within the context of busy primary care practices.
The Assessing Care of the Vulnerable Elderly (ACOVE) project, identified elders at
increased risk for death or functional decline and created quality indicators based on
literature review and expert panel for 22 conditions. They found that compliance for
geriatric conditions was worse than for general medical conditions (31% versus 52%).
Dr. David Reuben, from UCLA, has created a series of screening tools, office visit forms
and other resources that are focused on the identification of issues in the elderly. The
following forms can be found at the Web site listed below:
Pre-Visit Questionnaire – Initial Visit
Pre-Visit Questionnaire – Follow-up Visit
Screen (Patient)
Screen (Surrogate)
http://www.geronet.ucla.edu/centers/acove/office_forms.htm
Source: UCLA geronet Health & Aging Resources for Higher Education. 20-Minute
Medicare Exam Office Forms. Accessed December 29, 2008. Available at:
http://www.geronet.ucla.edu/
100608
Copyright © 2006 United HealthCare Services, Inc.