The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program is a federally mandated program under Title XIX of the Social Security Act. This program provides preventive and comprehensive health services for Medicaid-eligible individuals under age 21. The EPSDT Program is provided to Medicaid-eligible infants, children and youth. The primary goal is to offer prevention, early diagnosis and medically necessary treatment of conditions.

General Information

• EPSDT Notice

EPSDT Forms

The following forms are available for download. You will need Adobe Acrobat Reader to view these files.

• DHS 8015 Form (Rev. 01/10) Hawaii Early and Periodic, Screening Diagnosis, and Treatment (EPSDT) Exam
  • DHS 8015 Instructions (Rev. 01/10) General Instructions
• DHS 8015A Form (Rev. 07/07) Hawaii Early And Periodic, Screening Diagnosis, and Treatment (EPSDT) Exam Additional Information )
  • DHS 8015A Instructions (Rev. 08/13)
• DHS 8016 Form (Rev. 01/10) Hawaii Early And Periodic, Screening, Diagnosis, and Treatment (EPSDT) Immunization Catch Up & Follow-Up form
  • DHS 8016 Form Instructions