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Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument

CPT4 code

Name of the Procedure:

Administration of Patient-Focused Health Risk Assessment Instrument (e.g., Health Hazard Appraisal)


This procedure involves using a standardized questionnaire to evaluate individual health risks. The collected information is scored and documented to identify potential health issues and guide preventive measures.


The health risk assessment aims to uncover potential health hazards early, allowing for timely intervention. It seeks to improve overall health outcomes by promoting awareness and facilitating targeted medical advice and preventive care.


  • Adults seeking comprehensive understanding of their health status.
  • Individuals with multiple risk factors for chronic diseases.
  • Patients requiring a tailored health plan based on their risk profiles.


  • Complete any preliminary health questionnaires or forms provided by your healthcare provider.
  • Bring a list of current medications, including over-the-counter drugs and supplements.

Procedure Description

  1. The patient completes a detailed health questionnaire covering lifestyle, medical history, and potential risk factors.
  2. Healthcare professionals score the questionnaire based on established criteria.
  3. The results are documented in the patient's medical record.
  4. A healthcare provider reviews the findings with the patient, offering personalized recommendations.

Tools: Standardized health risk assessment instrument (questionnaire), scoring guidelines. Anesthesia: Not required.


Typically takes 30 to 60 minutes.


Conducted in various settings such as hospitals, outpatient clinics, or primary care offices.


  • Primary care physicians or specialists
  • Nurses or health coaches
  • Administrative staff

Risks and Complications

  • Minimal risk; mainly involves the accuracy and honesty in self-reporting of health information.
  • Potential for anxiety if high-risk scores are identified.


  • Early detection of health risks.
  • Personalized health recommendations.
  • Improved long-term health management.


  • No recovery time needed.
  • Immediate implementation of health recommendations.
  • Follow-up appointments as suggested by the healthcare provider.


  • General health check-ups without specific risk tool utilization.
  • Self-assessment tools available online, though less accurate and personalized.

Pros and cons of alternatives:

  • General check-ups provide broader health inspections but may miss specific risk-targeting.
  • Online tools offer convenience but lack professional interpretation and personalized guidance.

Patient Experience

Patients might find the questionnaire thorough but straightforward to complete. Discussions with healthcare providers post-assessment can be enlightening and motivating toward healthier lifestyle changes.

Medical Policies and Guidelines for Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument

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