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The Standard Medical Record Form (SMRF)

The Standard Medical Record Forms (SMRF) are a tool that DC providers can use if their practice does not currently use Electronic Medical Records (EMRs) to document HealthCheck visits.

Purpose of the DC HealthCheck SMRFs

The District of Columbia wants to ensure that all children and adolescents are receiving the best care possible. Pediatric providers recognize the health and developmental concerns facing the District's young people, the complexities of providing comprehensive well-child care, and the need to document that care efficiently.

To help meet these challenges, a collaborative work group of local pediatric providers, in consultation with the District of Columbia Department of Health Care Finance (DC DHCF), developed a set of Standard Medical Record Forms (SMRFs) in 2003-2005. The SMRFs have been designed as a well-child examination tool to help providers document health status if they do not currently record this information in EMRs.

Specifically, the SMRFs were designed to:

• Ensure that the District's youth receive all required health care services
• Advance the standards of care set forth by HealthCheck DC's EPSDT benefit and federal EPSDT regulations
• Help providers streamline documentation and maximize reimbursements
• Improve and standardize data collection, and establish linkages with the DC Immunization Registry
• Provide a mechanism to support mandated review activities and quality improvement initiatives

Authority, Credibility, and Peer Review

The SMRFs are in compliance with federal regulations (42 U.S.C. 1396(r)), and are based on the standards of care outlined in:

• The HealthCheck Periodicity Schedule, in consultation with the local medical community
• The American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care
• The Centers for Medicare & Medicaid Services (CMS) Medicaid Manual
• The Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents

Download the Standard Medical Record Forms (SMRFs)

You may download PDFs of the forms here.

SMRF # 1: 0 to 1 month (460 KB) SMRF # 2: 2 to 4 months (460 KB) SMRF # 3: 6 to 9 months (460 KB) SMRF # 4: 12 to 18 months (460 KB) SMRF # 5: 2 to 5 years (464 KB) SMRF # 6: 6 - 10 years (456 KB) SMRF # 7: 11 - 21 years (448 KB)