Well-Woman Annual Exam Template

The well-woman visit covers interval and gynecologic history, medical and family history, a screening table, examination, counseling and immunizations, and coding. The screening table asks for four things on every row: the screen, the test actually performed, the date and result, and when it is next due. That last column is the one that matters, because screening intervals now differ by test rather than by visit.

Cervical cancer screening changed in 2026. ACOG's current statement recommends cytology alone every three years for ages 21 to 29, clinician-collected primary hrHPV screening every five years for ages 30 to 65, and stopping after 65 with adequate prior negative screening. Any template built before that still presents three equivalent options for the 30 to 65 band. This one asks you to record the test and the next-due date rather than rely on a memorised interval, so it stays correct as guidance moves. The page also carries the Medicare rules that get billed wrong: G0101 for the screening pelvic and clinical breast exam and Q0091 for obtaining the Pap specimen, covered every 24 months at average risk and every 12 months for high risk, with Q0091 not separately billable when collection is already part of a preventive visit. Optimized for use with Sully.ai's AI medical scribe, it helps streamline note-taking and improve clinical efficiency.