The Early and Periodic Screening, Diagnostic 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.
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 8016 Form (Rev. 01/10) Hawaii Early And Periodic, Screening, Diagnosis, and Treatment (EPSDT) Immunization Catch Up & Follow-Up form
Hawaii CMS 416 Submissions