(2025) Periodic Health Examination: Evidence-Based Approach

Periodic Health Examination (PHE)
Definition, Objectives & Importance
Screening, Counseling & Immunization
Evidence-based Recommendations (USPSTF, AAFP, WHO)
Age- and Risk-Based Preventive Checklists
Approach in Primary Care & Family Medicine
Guideline Summary and Practical Application
For Medical Students, Residents, and Practicing Family Physicians

1. Periodic
Health
Examinations
Dr AbdulRahman Altokhy
Introduction & Definition
Criteria & Guideline
Approach & Counseling
Examination & Labs
Medication & Immunization
1
2
3
4
5
Contents

2. Periodic
Health
Examinations
Introduction & Definition
Criteria & Guideline
Approach & Counseling
Examination & Labs
Medication & Immunization
1
2
3
4
5
Contents
Periodic Health Examination
isanencounterwithagenerallyhealthyindividualinwhichpreventiveservices,screening,counseling,physical
examcomponents,andimmunizationsareconsideredandappliedappropriately,tailoredbyage,risk,andevidence.

3. WHO Screening Criteria (1968)
●Significant Condition.
The disease should cause significant morbidity or mortality in the population.
●Recognizable Latent Or Early Symptomatic.
The disease can be detected before major harm occurs.
●Well Understood Disease.
We must know how it progresses and when to intervene.
●Suitable Test.
The test should be safe, simple, reliable, and acceptable to the public.
●Accuratetest.
It should have good sensitivity (finds true cases) and specificity (avoids false alarms).
Periodic Health Examination
isanencounterwithagenerallyhealthyindividualinwhichpreventiveservices,screening,counseling,physical
examcomponents,andimmunizationsareconsideredandappliedappropriately,tailoredbyage,risk,andevidence.
Periodic
Health
Examinations
Introduction & Definition
Criteria & Guideline
Approach & Counseling
Examination & Labs
Medication & Immunization
1
2
3
4
5
Contents

4. ●Available Effective Treatment.
Early detection should actually improve outcomes.
●Available Facilities.
Detecting disease is pointless if care isn’t accessible.
●Reasonable cost-effect
in relation to both the total healthcare budget and the benefits gained.
●Continuous Screening.
Repeated testing is often needed to maintain benefit.
●Benefits > Harms.
Screening should reduce suffering or death more than it causes anxiety, overdiagnosis, or unnecessary procedures.
WHO Screening Criteria (1968)
●Significant Condition.
The disease should cause significant morbidity or mortality in the population.
●Recognizable Latent Or Early Symptomatic.
The disease can be detected before major harm occurs.
●Well Understood Disease.
We must know how it progresses and when to intervene.
●Suitable Test.
The test should be safe, simple, reliable, and acceptable to the public.
●Accuratetest.
It should have good sensitivity (finds true cases) and specificity (avoids false alarms).
Periodic Health Examination
isanencounterwithagenerallyhealthyindividualinwhichpreventiveservices,screening,counseling,physical
examcomponents,andimmunizationsareconsideredandappliedappropriately,tailoredbyage,risk,andevidence.

5. Screening Outcome Paradox
TRUE
POSTIVE
FALSE
POSTIVE
TRUE
NEGATIVE
FALSE
NEGATIVE
Treatment
Delay
Diagnosis
Reassurance
Anxiety
WHO Screening Criteria (1968)
●Available Effective Treatment.
Early detection should actually improve outcomes.
●Available Facilities.
Detecting disease is pointless if care isn’t accessible.
●Reasonable cost-effect
in relation to both the total healthcare budget and the benefits gained.
●Continuous Screening.
Repeated testing is often needed to maintain benefit.
●Benefits > Harms.
Screening should reduce suffering or death more than it causes anxiety, overdiagnosis, or unnecessary procedures.
●Significant Condition.
The disease should cause significant morbidity or mortality in the population.
●Recognizable Latent Or Early Symptomatic.
The disease can be detected before major harm occurs.
●Well Understood Disease.
We must know how it progresses and when to intervene.
●Suitable Test.
The test should be safe, simple, reliable, and acceptable to the public.
●Accuratetest.
It should have good sensitivity (finds true cases) and specificity (avoids false alarms).

6. Saudi Clinical Preventive Guideline
●Timeline:3
rd
editionat2023
●Updates:every2-3yearsorsoonerifnewevidenceemerges
●Evidencesources:USPSTF(primary);gapsfilledwithRACGP&CTFPHC;broadsearches(MEDLINE,Cochrane,
NICE,SIGN,G-I-N.).
●Recommendationgrading(USPSTF):A/B/C/D/Iwithclearimplicationsforpractice.
Screening Outcome Paradox
TRUE
POSTIVE
FALSE
POSTIVE
TRUE
NEGATIVE
FALSE
NEGATIVE
Treatment
Delay
Diagnosis
Reassurance
Anxiety
WHO Screening Criteria (1968)
●Available Effective Treatment.
Early detection should actually improve outcomes.
●Available Facilities.
Detecting disease is pointless if care isn’t accessible.
●Reasonable cost-effect
in relation to both the total healthcare budget and the benefits gained.
●Continuous Screening.
Repeated testing is often needed to maintain benefit.
●Benefits > Harms.
Screening should reduce suffering or death more than it causes anxiety, overdiagnosis, or unnecessary procedures.

7. Saudi Clinical Preventive Guideline
●Timeline:3
rd
editionat2023
●Updates:every2-3yearsorsoonerifnewevidenceemerges
●Evidencesources:USPSTF(primary);gapsfilledwithRACGP&CTFPHC;broadsearches(MEDLINE,Cochrane,
NICE,SIGN,G-I-N.).
●Recommendationgrading(USPSTF):A/B/C/D/Iwithclearimplicationsforpractice.
Under 6y
6y-17y
18y-59y
+60y
Counseling
Screening
(Physical examination -Labs)
Chemoprophylaxis
(Medication –Immunizations)
Screening Outcome Paradox
TRUE
POSTIVE
FALSE
POSTIVE
TRUE
NEGATIVE
FALSE
NEGATIVE
Treatment
Delay
Diagnosis
Reassurance
Anxiety

8. Saudi Clinical Preventive Guideline
●Timeline:3
rd
editionat2023
●Updates:every2-3yearsorsoonerifnewevidenceemerges
●Evidencesources:USPSTF(primary);gapsfilledwithRACGP&CTFPHC;broadsearches(MEDLINE,Cochrane,
NICE,SIGN,G-I-N.).
●Recommendationgrading(USPSTF):A/B/C/D/Iwithclearimplicationsforpractice.
Under 6y 6y-17y 18y-59y +60y
Counseling
Screening
(Physical examination -Labs)
Chemoprophylaxis
(Medication –Immunizations)
Screening Outcome Paradox
TRUE
POSTIVE
FALSE
POSTIVE
TRUE
NEGATIVE
FALSE
NEGATIVE
Treatment
Delay
Diagnosis
Reassurance
Anxiety

9. USPSTF Recommendation Grading
Grade Suggestions for Practice
A
High Benefits
Offer or provide this service.
B
Moderate Benefits
Offer or provide this service.
C
Small Benefits
D
Harmful or No Benefits
Discourage the use of this service.
I
Insufficient evidence to recommend with or
against
Saudi Clinical Preventive Guideline
●Timeline:3
rd
editionat2023
●Updates:every2-3yearsorsoonerifnewevidenceemerges
●Evidencesources:USPSTF(primary);gapsfilledwithRACGP&CTFPHC;broadsearches(MEDLINE,Cochrane,
NICE,SIGN,G-I-N.).
●Recommendationgrading(USPSTF):A/B/C/D/Iwithclearimplicationsforpractice.
Under 6y 6y-17y 18y-59y +60y
Counseling
Screening
(Physical examination -Labs)
Chemoprophylaxis
(Medication –Immunizations)
Screening Outcome Paradox
TRUE
POSTIVE
FALSE
POSTIVE
TRUE
NEGATIVE
FALSE
NEGATIVE
Treatment
Delay
Diagnosis
Reassurance
Anxiety

10. Smoking
SaudiClinicalPreventiveGuideline:
●[U6]A—Zeroexposure;askeveryWCC.
●[6–17]B—Preventinitiation;briefcounseling,document0pack-year.
●[18–59]A—5A’s+FDA-approvedpharmacotherapy;everyvisit.
●[60+]A—5A’s+FDA-approvedpharmacotherapy;everyvisit.
CTFPHC(Canada):Newguidelinerecommendingaskingalladultsabouttobaccouseandofferingeffective
behavioral+pharmacologicsupportsfortobaccosmokingcessation(Aug2025)
USPSTF Recommendation Grading
Grade Suggestions for Practice
A
High Benefits
Offer or provide this service.
B
Moderate Benefits
Offer or provide this service.
C
Small Benefits
Offer or provide this service for selected patients
D
Harmful or No Benefits
Discourage the use of this service.
I
Insufficient evidence to recommend with or
against
Saudi Clinical Preventive Guideline
Under 6y 6y-17y 18y-59y +60y
Counseling
Screening
(Physical examination -Labs)
Chemoprophylaxis
(Medication –Immunizations)
●Timeline:3
rd
editionat2023
●Updates:every2-3yearsorsoonerifnewevidenceemerges
●Evidencesources:USPSTF(primary);gapsfilledwithRACGP&CTFPHC;broadsearches(MEDLINE,Cochrane,
NICE,SIGN,G-I-N.).
●Recommendationgrading(USPSTF):A/B/C/D/Iwithclearimplicationsforpractice.
Counselling
.

11. Smoking
SaudiClinicalPreventiveGuideline:
●[U6]A—Zeroexposure;askeveryWCC.
●[6–17]B—Preventinitiation;briefcounseling,document0pack-year.
●[18–59]A—5A’s+FDA-approvedpharmacotherapy;everyvisit.
●[60+]A—5A’s+FDA-approvedpharmacotherapy;everyvisit.
CTFPHC(Canada):Newguidelinerecommendingaskingalladultsabouttobaccouseandofferingeffective
behavioral+pharmacologicsupportsfortobaccosmokingcessation(Aug2025)
USPSTF Recommendation Grading
Grade Suggestions for Practice
A
High Benefits
Offer or provide this service.
B
Moderate Benefits
Offer or provide this service.
C
Small Benefits
Offer or provide this service for selected patients
D
Harmful or No Benefits
Discourage the use of this service.
I
Insufficient evidence to recommend with or
against
Counselling
.

12. ASK ●About tobacco/nicotine each visit and document: type, amount, pack-years
ADVISE ●Clear, strong, personalized: “Quitting is the best for your health; I can help
ASSESS ●Readiness to quit within 30 days; confidence, barriers.
ASSIST ●Set quit date; remove triggers; coping plan. Provide Pharmacotherapy
ARRANGE ●Follow-ups: 1 week, 1 month, 3 months; monitor/adjust.
USPSTF Recommendation Grading
Grade Suggestions for Practice
A
High Benefits
Offer or provide this service.
B
Moderate Benefits
Offer or provide this service.
C
Small Benefits
D
Harmful or No Benefits
Discourage the use of this service.
I
Insufficient evidence to recommend with or
against
Smoking
SaudiClinicalPreventiveGuideline:
●[U6]A—Zeroexposure;askeveryWCC.
●[6–17]B—Preventinitiation;briefcounseling,document0pack-year.
●[18–59]A—5A’s+FDA-approvedpharmacotherapy;everyvisit.
●[60+]A—5A’s+FDA-approvedpharmacotherapy;everyvisit.
CTFPHC(Canada):Newguidelinerecommendingaskingalladultsabouttobaccouseandofferingeffective
behavioral+pharmacologicsupportsfortobaccosmokingcessation(Aug2025)
Counselling

13. Oral Hygiene
Supporttoothbrushinginchildren&recommendpersonaltoothbrushingandflossinginadultstopreventgingivitis
SaudiClinicalPreventiveGuideline:
●[U6]Brush/avoidbottleinbed;dentalvarnishplan;everyWCC.
●[6–17]Brush2×/dayfluoride;dentistq6–12mo.
●[18–59]Brush/floss;dentistq6–12mo.
Smoking
ASK ●About tobacco/nicotine each visit and document: type, amount, pack-years
ADVISE ●Clear, strong, personalized: “Quitting is the best for your health; I can help
ASSESS ●Readiness to quit within 30 days; confidence, barriers.
ASSIST ●Set quit date; remove triggers; coping plan. Provide Pharmacotherapy
ARRANGE ●Follow-ups: 1 week, 1 month, 3 months; monitor/adjust.
Counselling
SaudiClinicalPreventiveGuideline:
●[U6]A—Zeroexposure;askeveryWCC.
●[6–17]B—Preventinitiation;briefcounseling,document0pack-year.
●[18–59]A—5A’s+FDA-approvedpharmacotherapy;everyvisit.
●[60+]A—5A’s+FDA-approvedpharmacotherapy;everyvisit.
CTFPHC(Canada):Newguidelinerecommendingaskingalladultsabouttobaccouseandofferingeffective
behavioral+pharmacologicsupportsfortobaccosmokingcessation(Aug2025)

14. Sun Exposure & Vitamin D
●5–30minofsunexposurebetween10AM&3PMatleast2×/wktotheface,arms,legs,orback(~25–50%skin
exposed)withoutsunscreen.
●Fullcoverageclothing(e.g.,abaya,thobe,longdresses,headcoverings)=almostnoUVBexposure,meaning
vitaminDsynthesis≈zero,eveninstrongsunlight.
SaudiClinicalPreventiveGuideline:
●[U6]RDA(400IU<1y;600IU≥1y).
●[6–17]Balancedsunprotection;RDA≈600IU/diflowexposureorlimitedindiet.
●[18–59]Counselsunsafety;don’tscreenvitDroutinely.
Oral Hygiene
Supporttoothbrushinginchildren&recommendpersonaltoothbrushingandflossinginadultstopreventgingivitis
SaudiClinicalPreventiveGuideline:
●[U6]Brush/avoidbottleinbed;dentalvarnishplan;everyWCC.
●[6–17]Brush2×/dayfluoride;dentistq6–12mo.
●[18–59]Brush/floss;dentistq6–12mo.
Counselling
ASK ●About tobacco/nicotine each visit and document: type, amount, pack-years
ADVISE ●Clear, strong, personalized: “Quitting is the best for your health; I can help
ASSESS ●Readiness to quit within 30 days; confidence, barriers.
ASSIST ●Set quit date; remove triggers; coping plan. Provide Pharmacotherapy
ARRANGE ●Follow-ups: 1 week, 1 month, 3 months; monitor/adjust.
Smoking

15. Food Vitamin D (IU)
~1400–450
~450–900
~150–200
~180–250
~40–45
~40–50
-exposed) ½ cup ~300–700
~0–10
~100–150
28 g ~5–15
Sun Exposure & Vitamin D
●5–30minofsunexposurebetween10AM&3PMatleast2×/wktotheface,arms,legs,orback(~25–50%skin
exposed)withoutsunscreen.
●Fullcoverageclothing(e.g.,abaya,thobe,longdresses,headcoverings)=almostnoUVBexposure,meaning
vitaminDsynthesis≈zero,eveninstrongsunlight.
SaudiClinicalPreventiveGuideline:
●[U6]RDA(400IU<1y;600IU≥1y).
●[6–17]Balancedsunprotection;RDA≈600IU/diflowexposureorlimitedindiet.
●[18–59]Counselsunsafety;don’tscreenvitDroutinely.
Counselling
Oral Hygiene
Supporttoothbrushinginchildren&recommendpersonaltoothbrushingandflossinginadultstopreventgingivitis
SaudiClinicalPreventiveGuideline:
●[U6]Brush/avoidbottleinbed;dentalvarnishplan;everyWCC.
●[6–17]Brush2×/dayfluoride;dentistq6–12mo.
●[18–59]Brush/floss;dentistq6–12mo.

16. Depression
SaudiClinicalPreventiveGuideline:
●[6–17]B—PHQ-A(12–18)whentreatingsystemexists.
●[18–59]B—PHQ-2→9(+EPDSperinatal);annualorPRN.
●[60+]B—PHQ-2→9annually(moreoftenwithrisks)orUseGeriatricDepressionScale(shortform).
PHQ-A:AdaptedfromthePHQ-9butusessimplifiedlanguageappropriateforteens.
Sun Exposure & Vitamin D
Food Vitamin D (IU)
Cod liver oil, 1 tsp ~1400–450
Salmon, cooked 85 g ~450–900
Tuna (light), canned 85 g ~150–200
Sardines, canned in oil 85 g ~180–250
Egg, 1 large ~40–45
Beef liver, cooked 85 g ~40–50
Mushrooms (UV-exposed) ½ cup ~300–700
Regular mushrooms (no UV) ½ cup ~0–10
Cow Milk, fortified w/ vit D, 1 cup ~100–150
Cheese 28 g ~5–15
Counselling
●5–30minofsunexposurebetween10AM&3PMatleast2×/wktotheface,arms,legs,orback(~25–50%skin
exposed)withoutsunscreen.
●Fullcoverageclothing(e.g.,abaya,thobe,longdresses,headcoverings)=almostnoUVBexposure,meaning
vitaminDsynthesis≈zero,eveninstrongsunlight.
SaudiClinicalPreventiveGuideline:
●[U6]RDA(400IU<1y;600IU≥1y).
●[6–17]Balancedsunprotection;RDA≈600IU/diflowexposureorlimitedindiet.
●[18–59]Counselsunsafety;don’tscreenvitDroutinely.

17. Anxiety
SaudiClinicalPreventiveGuideline:
●[6–17]B-SCARED/GAD-7(8–18)whentreatingsystemexists
●[18–59][60+]B—Adults64yearsoryounger,includingpregnantandpostpartum
SCARED:Designedforchildrenandadolescents(8–18years).Screensforawiderangeofanxietydisorders,notjust
generalizedanxiety.
GAD-7:Measuresseverityofgeneralizedanxietysymptomsinadultsandadolescents≥13yrs.Focusesnarrowlyon
GAD(notpanicorsocialphobia)
Depression
SaudiClinicalPreventiveGuideline:
●[6–17]B—PHQ-A(12–18)whentreatingsystemexists.
●[18–59]B—PHQ-2→9(+EPDSperinatal);annualorPRN.
●[60+]B—PHQ-2→9annually(moreoftenwithrisks)orUseGeriatricDepressionScale(shortform).
PHQ-A:AdaptedfromthePHQ-9butusessimplifiedlanguageappropriateforteens.
Counselling
Food Vitamin D (IU)
~1400–450
~450–900
~150–200
~180–250
~40–45
~40–50
-exposed) ½ cup ~300–700
~0–10
~100–150
28 g ~5–15
Sun Exposure & Vitamin D

18. Domestic Violence & Abuse
SaudiClinicalPreventiveGuideline:
●[6–17]B—askprivately;support/referral.
●[18–59]B—screenallwomenofreproductiveageeachannualvisit/pregnancy.
USPSTF:B(Jun24,2025):Screenwomenofreproductiveage(includingpregnant/postpartum);evidence
insufficientforscreeningcaregiverabuseinolder/vulnerableadults.
Anxiety
SaudiClinicalPreventiveGuideline:
●[6–17]B-SCARED/GAD-7(8–18)whentreatingsystemexists
●[18–59][60+]B—Adults64yearsoryounger,includingpregnantandpostpartum
SCARED:Designedforchildrenandadolescents(8–18years).Screensforawiderangeofanxietydisorders,notjust
generalizedanxiety.
GAD-7:Measuresseverityofgeneralizedanxietysymptomsinadultsandadolescents≥13yrs.Focusesnarrowlyon
GAD(notpanicorsocialphobia)
Counselling
Depression
SaudiClinicalPreventiveGuideline:
●[6–17]B—PHQ-A(12–18)whentreatingsystemexists.
●[18–59]B—PHQ-2→9(+EPDSperinatal);annualorPRN.
●[60+]B—PHQ-2→9annually(moreoftenwithrisks)orUseGeriatricDepressionScale(shortform).
PHQ-A:AdaptedfromthePHQ-9butusessimplifiedlanguageappropriateforteens.

19. Alcohol Use
SaudiClinicalPreventiveGuideline:
●[18–59]B—AUDIT-C/SASQatintake+annual;briefinterventionifrisky.
●[60+]B—AUDIT-CannuallyandPRN.
Domestic Violence & Abuse
SaudiClinicalPreventiveGuideline:
●[6–17]B—askprivately;support/referral.
●[18–59]B—screenallwomenofreproductiveageeachannualvisit/pregnancy.
USPSTF:B(Jun24,2025):Screenwomenofreproductiveage(includingpregnant/postpartum);evidence
insufficientforscreeningcaregiverabuseinolder/vulnerableadults.
Counselling
Anxiety
SaudiClinicalPreventiveGuideline:
●[6–17]B-SCARED/GAD-7(8–18)whentreatingsystemexists
●[18–59][60+]B—Adults64yearsoryounger,includingpregnantandpostpartum
SCARED:Designedforchildrenandadolescents(8–18years).Screensforawiderangeofanxietydisorders,notjust
generalizedanxiety.
GAD-7:Measuresseverityofgeneralizedanxietysymptomsinadultsandadolescents≥13yrs.Focusesnarrowlyon
GAD(notpanicorsocialphobia)

20. AUDIT -10 Question Domain
1 How often do you have a drink containing alcohol? C (Consumption)
2 How many drinks containing alcohol do you have on a typical day when you are drinking? C (Consumption)
3 How often do you have six or more drinks on one occasion? C (Consumption)
4 How often during the last year have you found that you were not able to stop drinking once you had started? D (Dependence)
5 How often during the last year have you failed to do what was expected of you because of alcohol? D (Dependence)
6 How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? D (Dependence)
7 How often during the last year have you had a feeling of guilt or remorse after drinking? H (Harmful use)
8 How often during the last year have you been unable to remember what happened the night before because of your drinking?H (Harmful use)
9 Have you or someone else been injured because of your drinking? H (Harmful use)
10Has a relative, friend, doctor or other healthcare worker been concerned about your drinking or suggested you cut down?H (Harmful use)
●AUDIT-C:3-itemshortformfocusingonlyonalcoholconsumptionfrequencyandquantitytoflagriskydrinkers.
●SASQ:Asingle-questionrapidscreenaskingaboutheavydrinkingdaysinthepastyeartoquicklydetectriskyuse.
(Howmanytimesinthepastyearhaveyouhadfive(formen)orfour(forwomen)ormoredrinksinaday?)
Alcohol Use
SaudiClinicalPreventiveGuideline:
●[18–59]B—AUDIT-C/SASQatintake+annual;briefinterventionifrisky.
●[60+]B—AUDIT-CannuallyandPRN.
Counselling
Domestic Violence & Abuse
SaudiClinicalPreventiveGuideline:
●[6–17]B—askprivately;support/referral.
●[18–59]B—screenallwomenofreproductiveageeachannualvisit/pregnancy.
USPSTF:B(Jun24,2025):Screenwomenofreproductiveage(includingpregnant/postpartum);evidence
insufficientforscreeningcaregiverabuseinolder/vulnerableadults.

21. Substance Use
SaudiClinicalPreventiveGuideline:
●[6–17][18–59]B—Briefriskchat;CRAFFTifconcern;nouniversalscreeninggrade.
Alcohol Use
AUDIT -10 Question Domain
1 How often do you have a drink containing alcohol? C (Consumption)
2 How many drinks containing alcohol do you have on a typical day when you are drinking? C (Consumption)
3 How often do you have six or more drinks on one occasion? C (Consumption)
4 How often during the last year have you found that you were not able to stop drinking once you had started? D (Dependence)
5 How often during the last year have you failed to do what was expected of you because of alcohol? D (Dependence)
6 How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? D (Dependence)
7 How often during the last year have you had a feeling of guilt or remorse after drinking? H (Harmful use)
8 How often during the last year have you been unable to remember what happened the night before because of your drinking?H (Harmful use)
9 Have you or someone else been injured because of your drinking? H (Harmful use)
10Has a relative, friend, doctor or other healthcare worker been concerned about your drinking or suggested you cut down?H (Harmful use)
●AUDIT-C:3-itemshortformfocusingonlyonalcoholconsumptionfrequencyandquantitytoflagriskydrinkers.
●SASQ:Asingle-questionrapidscreenaskingaboutheavydrinkingdaysinthepastyeartoquicklydetectriskyuse.
(Howmanytimesinthepastyearhaveyouhadfive(formen)orfour(forwomen)ormoredrinksinaday?)
Counselling
SaudiClinicalPreventiveGuideline:
●[18–59]B—AUDIT-C/SASQatintake+annual;briefinterventionifrisky.
●[60+]B—AUDIT-CannuallyandPRN.

22. Question Domain
C
Have you ever ridden in a car driven by someone (including yourself) who was high or had been
using alcohol or drugs?
Car / Safety risk
RDo you ever use alcohol or drugs to relax, feel better about yourself, or fit in? Relax / Emotional use
ADo you ever use alcohol or drugs while you are by yourself? Alone / Solitary use
FDo you ever forget things you did while using alcohol or drugs? Forget / Memory loss
FDo your family or friends ever tell you that you should cut down on your drinking or drug use?Friends / Feedback concern
THave you ever gotten into trouble while you were using alcohol or drugs? Trouble / Consequences
CRAFFT
●Avalidatedtoolfordetectingsubstanceuseandriskbehaviorsinadolescents(ages12–21).
●If“Yes”toanyofthe1stthreequestions(PartA),continuewiththe2
nd
threequestions(PartB).
●Score≥2→Positivescreen(suggestsneedforfurtherassessmentforsubstanceusedisorder)
Substance Use
SaudiClinicalPreventiveGuideline:
●[6–17][18–59]B—Briefriskchat;CRAFFTifconcern;nouniversalscreeninggrade.
Counselling
Alcohol Use
AUDIT -10 Question Domain
1 How often do you have a drink containing alcohol? C (Consumption)
2 How many drinks containing alcohol do you have on a typical day when you are drinking? C (Consumption)
3 How often do you have six or more drinks on one occasion? C (Consumption)
4 How often during the last year have you found that you were not able to stop drinking once you had started? D (Dependence)
5 How often during the last year have you failed to do what was expected of you because of alcohol? D (Dependence)
6 How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? D (Dependence)
7 How often during the last year have you had a feeling of guilt or remorse after drinking? H (Harmful use)
8 How often during the last year have you been unable to remember what happened the night before because of your drinking?H (Harmful use)
9 Have you or someone else been injured because of your drinking? H (Harmful use)
10Has a relative, friend, doctor or other healthcare worker been concerned about your drinking or suggested you cut down?H (Harmful use)
●AUDIT-C:3-itemshortformfocusingonlyonalcoholconsumptionfrequencyandquantitytoflagriskydrinkers.
●SASQ:Asingle-questionrapidscreenaskingaboutheavydrinkingdaysinthepastyeartoquicklydetectriskyuse.
(Howmanytimesinthepastyearhaveyouhadfive(formen)orfour(forwomen)ormoredrinksinaday?)

23. ADHD (Counsel/Screen)
SaudiClinicalPreventiveGuideline:
●[U6]B—Evaluateage≥4ywhenacademic/behaviorconcerns(inattention/hyperactivity/impulsivity).
●[6–17]Evaluateanychildwithconcerns;notgeneral-populationscreening.
AAP:recommendsanevaluationforADHDforanychildoradolescentage4yearstothe18thbirthdaywho
presentswithacademicorbehavioralproblemsandsymptomsofinattention,hyperactivity,orimpulsivity.
Substance Use
Question Domain
C
Have you ever ridden in a car driven by someone (including yourself) who was high or had been
using alcohol or drugs?
Car / Safety risk
RDo you ever use alcohol or drugs to relax, feel better about yourself, or fit in? Relax / Emotional use
ADo you ever use alcohol or drugs while you are by yourself? Alone / Solitary use
FDo you ever forget things you did while using alcohol or drugs? Forget / Memory loss
FDo your family or friends ever tell you that you should cut down on your drinking or drug use?Friends / Feedback concern
THave you ever gotten into trouble while you were using alcohol or drugs? Trouble / Consequences
CRAFFT
●Avalidatedtoolfordetectingsubstanceuseandriskbehaviorsinadolescents(ages12–21).
●If“Yes”toanyofthe1stthreequestions(PartA),continuewiththe2
nd
threequestions(PartB).
●Score≥2→Positivescreen(suggestsneedforfurtherassessmentforsubstanceusedisorder)
Counselling
SaudiClinicalPreventiveGuideline:
●[6–17][18–59]B—Briefriskchat;CRAFFTifconcern;nouniversalscreeninggrade.

24. Statement
1 = never, 2 = occasionally, 3 = often, 4 = very often
Does not pay attention to details or makes careless mistakes, such as in homework☐1 ☐2 ☐3 ☐4
Has difficulty sustaining attention to tasks or activities ☐1 ☐2 ☐3 ☐4
Does not seem to listen when spoken to directly ☐1 ☐2 ☐3 ☐4
Does not follow through on instruction and fails to finish schoolwork ☐1 ☐2 ☐3 ☐4
Has difficulty organizing tasks and activities ☐1 ☐2 ☐3 ☐4
Avoids, dislikes, or is reluctant to engage in tasks that require sustaining mental effort☐1 ☐2 ☐3 ☐4
Loses things necessary for tasks or activities (school assignments, pencils, or books)☐1 ☐2 ☐3 ☐4
Is easily distracted by extraneous stimuli ☐1 ☐2 ☐3 ☐4
Is forgetful in daily activities ☐1 ☐2 ☐3 ☐4
Fidgets with hands or feet or squirms in seat ☐1 ☐2 ☐3 ☐4
Leaves seat in classroom or in other situations in which remaining seated is expected☐1 ☐2 ☐3 ☐4
Runs about or climbs excessively in situations in which remaining seated is expected☐1 ☐2 ☐3 ☐4
Has difficulty playing or engaging in leisure activities quietly ☐1 ☐2 ☐3 ☐4
Is "on the go" or often acts as if "driven by a motor" ☐1 ☐2 ☐3 ☐4
Talks excessively ☐1 ☐2 ☐3 ☐4
Blurts out answers before questions have been completed ☐1 ☐2 ☐3 ☐4
VanderbiltADHDScoring:
TomeetADHDcriteria,atleast
6(“often”)or3(“veryoften”)
inadomainplusevidenceof
impairmentathomeorschool.
ADHD (Counsel/Screen)
SaudiClinicalPreventiveGuideline:
●[U6]B—Evaluateage≥4ywhenacademic/behaviorconcerns(inattention/hyperactivity/impulsivity).
●[6–17]Evaluateanychildwithconcerns;notgeneral-populationscreening.
AAP:recommendsanevaluationforADHDforanychildoradolescentage4yearstothe18thbirthdaywho
presentswithacademicorbehavioralproblemsandsymptomsofinattention,hyperactivity,orimpulsivity.
Counselling
Substance Use
Question Domain
C
Have you ever ridden in a car driven by someone (including yourself) who was high or had been
using alcohol or drugs?
Car / Safety risk
RDo you ever use alcohol or drugs to relax, feel better about yourself, or fit in? Relax / Emotional use
ADo you ever use alcohol or drugs while you are by yourself? Alone / Solitary use
FDo you ever forget things you did while using alcohol or drugs? Forget / Memory loss
FDo your family or friends ever tell you that you should cut down on your drinking or drug use?Friends / Feedback concern
THave you ever gotten into trouble while you were using alcohol or drugs? Trouble / Consequences
CRAFFT
●Avalidatedtoolfordetectingsubstanceuseandriskbehaviorsinadolescents(ages12–21).
●If“Yes”toanyofthe1stthreequestions(PartA),continuewiththe2
nd
threequestions(PartB).
●Score≥2→Positivescreen(suggestsneedforfurtherassessmentforsubstanceusedisorder)

25. Breastfeeding
SaudiClinicalPreventiveGuideline:
●[U6]B—exclusiveBFsupport;techniquechecksat2wk,2/4/6m.
●[18–59]B—Post-partumcounseling;breastfeedingeducationreferralatdischarge+1–2wk.
USPSTF:B(Apr11,2025):Provideinterventions/referralsduringpregnancyandpostpartum
ADHD (Counsel/Screen)
Statement
1 = never, 2 = occasionally, 3 = often, 4 = very often
Does not pay attention to details or makes careless mistakes, such as in homework☐1 ☐2 ☐3 ☐4
Has difficulty sustaining attention to tasks or activities ☐1 ☐2 ☐3 ☐4
Does not seem to listen when spoken to directly ☐1 ☐2 ☐3 ☐4
Does not follow through on instruction and fails to finish schoolwork ☐1 ☐2 ☐3 ☐4
Has difficulty organizing tasks and activities ☐1 ☐2 ☐3 ☐4
Avoids, dislikes, or is reluctant to engage in tasks that require sustaining mental effort☐1 ☐2 ☐3 ☐4
Loses things necessary for tasks or activities (school assignments, pencils, or books)☐1 ☐2 ☐3 ☐4
Is easily distracted by extraneous stimuli ☐1 ☐2 ☐3 ☐4
Is forgetful in daily activities ☐1 ☐2 ☐3 ☐4
Fidgets with hands or feet or squirms in seat ☐1 ☐2 ☐3 ☐4
Leaves seat in classroom or in other situations in which remaining seated is expected☐1 ☐2 ☐3 ☐4
Runs about or climbs excessively in situations in which remaining seated is expected☐1 ☐2 ☐3 ☐4
Has difficulty playing or engaging in leisure activities quietly ☐1 ☐2 ☐3 ☐4
Is "on the go" or often acts as if "driven by a motor" ☐1 ☐2 ☐3 ☐4
Talks excessively ☐1 ☐2 ☐3 ☐4
Blurts out answers before questions have been completed ☐1 ☐2 ☐3 ☐4
VanderbiltADHDScoring:
TomeetADHDcriteria,atleast
6(“often”)or3(“veryoften”)
inadomainplusevidenceof
impairmentathomeorschool.
Counselling
SaudiClinicalPreventiveGuideline:
●[U6]B—Evaluateage≥4ywhenacademic/behaviorconcerns(inattention/hyperactivity/impulsivity).
●[6–17]Evaluateanychildwithconcerns;notgeneral-populationscreening.
AAP:recommendsanevaluationforADHDforanychildoradolescentage4yearstothe18thbirthdaywho
presentswithacademicorbehavioralproblemsandsymptomsofinattention,hyperactivity,orimpulsivity.

26. Breastfeeding
SaudiClinicalPreventiveGuideline:
●[U6]B—exclusiveBFsupport;techniquechecksat2wk,2/4/6m.
●[18–59]B—Post-partumcounseling;breastfeedingeducationreferralatdischarge+1–2wk.
USPSTF:B(Apr11,2025):Provideinterventions/referralsduringpregnancyandpostpartum
Counselling
ADHD (Counsel/Screen)
Statement
1 = never, 2 = occasionally, 3 = often, 4 = very often
Does not pay attention to details or makes careless mistakes, such as in homework☐1 ☐2 ☐3 ☐4
Has difficulty sustaining attention to tasks or activities ☐1 ☐2 ☐3 ☐4
Does not seem to listen when spoken to directly ☐1 ☐2 ☐3 ☐4
Does not follow through on instruction and fails to finish schoolwork ☐1 ☐2 ☐3 ☐4
Has difficulty organizing tasks and activities ☐1 ☐2 ☐3 ☐4
Avoids, dislikes, or is reluctant to engage in tasks that require sustaining mental effort☐1 ☐2 ☐3 ☐4
Loses things necessary for tasks or activities (school assignments, pencils, or books)☐1 ☐2 ☐3 ☐4
Is easily distracted by extraneous stimuli ☐1 ☐2 ☐3 ☐4
Is forgetful in daily activities ☐1 ☐2 ☐3 ☐4
Fidgets with hands or feet or squirms in seat ☐1 ☐2 ☐3 ☐4
Leaves seat in classroom or in other situations in which remaining seated is expected☐1 ☐2 ☐3 ☐4
Runs about or climbs excessively in situations in which remaining seated is expected☐1 ☐2 ☐3 ☐4
Has difficulty playing or engaging in leisure activities quietly ☐1 ☐2 ☐3 ☐4
Is "on the go" or often acts as if "driven by a motor" ☐1 ☐2 ☐3 ☐4
Talks excessively ☐1 ☐2 ☐3 ☐4
Blurts out answers before questions have been completed ☐1 ☐2 ☐3 ☐4
VanderbiltADHDScoring:
TomeetADHDcriteria,atleast
6(“often”)or3(“veryoften”)
inadomainplusevidenceof
impairmentathomeorschool.
Education:
●Hungercues:rooting,hand-to-mouth,cryingislate.
●GoodLatch:widemouth(~140°),lipsflanged,moreareolavisibleabovethanbelow.
●Effectivefeed:audibleswallows,suck–pause–swallowrhythm,softeningbreast.
●Frequency:ondemand,~8–12feeds/24h;avoidtimedlimits.
●Outputtargets:fromDay4–5onward≥6wets,≥3–4stools/24h.
Bad (shallow) latch
●Mouth open a little
●Only nipple is covered
●Chin not against breast
Good (Deep) latch
●Mouth wide open
●Most of areola covered
●Chin against breast

27. Breastfeeding
Education:
●Hungercues:rooting,hand-to-mouth,cryingislate.
●GoodLatch:widemouth(~140°),lipsflanged,moreareolavisibleabovethanbelow.
●Effectivefeed:audibleswallows,suck–pause–swallowrhythm,softeningbreast.
●Frequency:ondemand,~8–12feeds/24h;avoidtimedlimits.
●Outputtargets:fromDay4–5onward≥6wets,≥3–4stools/24h.
Bad (shallow) latch
●Mouth open a little
●Only nipple is covered
●Chin not against breast
Good (Deep) latch
●Mouth wide open
●Most of areola covered
●Chin against breast
Counselling
SaudiClinicalPreventiveGuideline:
●[U6]B—exclusiveBFsupport;techniquechecksat2wk,2/4/6m.
●[18–59]B—Post-partumcounseling;breastfeedingeducationreferralatdischarge+1–2wk.
USPSTF:B(Apr11,2025):Provideinterventions/referralsduringpregnancyandpostpartum
Home Safety & Accident Prevention
SaudiClinicalPreventiveGuideline:
●[U6]Safesleep,carseat,burns/drowning/poisoning;everyWCC.
●[U6]A—Age-appropriateinjury-proofing;supervisenearwater/heights;everyWCC.

28. Gaming & Screen-time Limits
SaudiClinicalPreventiveGuideline:
[U6]:revieweveryWCC
●<2years:avoid(exceptvideochat).
●Preschool:≤1h/dayhigh-quality;co-view;protectsleep/physicalplay.
●School-age:Don’tletmediadisplaceotherimportantactivitiessuchasqualitysleep,regularexercise,family
meals,“unplugged”downtime.
Home Safety & Accident Prevention
SaudiClinicalPreventiveGuideline:
●[U6]Safesleep,carseat,burns/drowning/poisoning;everyWCC.
●[U6]A—Age-appropriateinjury-proofing;supervisenearwater/heights;everyWCC.
Counselling
Breastfeeding
Education:
●Hungercues:rooting,hand-to-mouth,cryingislate.
●GoodLatch:widemouth(~140°),lipsflanged,moreareolavisibleabovethanbelow.
●Effectivefeed:audibleswallows,suck–pause–swallowrhythm,softeningbreast.
●Frequency:ondemand,~8–12feeds/24h;avoidtimedlimits.
●Outputtargets:fromDay4–5onward≥6wets,≥3–4stools/24h.
Bad (shallow) latch
●Mouth open a little
●Only nipple is covered
●Chin not against breast
Good (Deep) latch
●Mouth wide open
●Most of areola covered
●Chin against breast

29. Developmental Delays & Disabilities
SaudiClinicalPreventiveGuideline:
●[U6]Universalsurveillance/screeningat9,18,30m(validatedtools).
AAP:recommendsthatallchildrenbescreenedfordevelopmentaldelaysanddisabilitiesduringregularwell-child
doctorvisitsat:-9months-18months-30months
Gaming & Screen-time Limits
SaudiClinicalPreventiveGuideline:
[U6]:revieweveryWCC
●<2years:avoid(exceptvideochat).
●Preschool:≤1h/dayhigh-quality;co-view;protectsleep/physicalplay.
●School-age:Don’tletmediadisplaceotherimportantactivitiessuchasqualitysleep,regularexercise,family
meals,“unplugged”downtime.
Counselling
Home Safety & Accident Prevention
SaudiClinicalPreventiveGuideline:
●[U6]Safesleep,carseat,burns/drowning/poisoning;everyWCC.
●[U6]A—Age-appropriateinjury-proofing;supervisenearwater/heights;everyWCC.

30. Red Flags In Child Development
2 months
No startle/response to loud soundsNo visual tracking/hand-following Poor head control on pull-to-sit
4 months
Can’t hold head up in prone Can’t track all directions Obvious squint/strabismus
6 months
Not sitting without support Not rolling both directions Doesn’t respond to name
9 months
Not sitting independently Doesn’t bear weight on legs No babbling (“mama/baba/dada”)
12 months
No pointing to share interestNo gestures (bye-bye, hi-five, salam) Regression: loses words/social skills
18 months
No single-word vocabulary ≥15 words Not walking independently Regression: loses words/social skills
24 months
Doesn’t follow simple commands<50 single words/ no two-word phrasesRegression: loses previously gained skills
Developmental Delays & Disabilities
SaudiClinicalPreventiveGuideline:
●[U6]Universalsurveillance/screeningat9,18,30m(validatedtools).
AAP:recommendsthatallchildrenbescreenedfordevelopmentaldelaysanddisabilitiesduringregularwell-child
doctorvisitsat:-9months-18months-30months
Counselling
Gaming & Screen-time Limits
SaudiClinicalPreventiveGuideline:
[U6]:revieweveryWCC
●<2years:avoid(exceptvideochat).
●Preschool:≤1h/dayhigh-quality;co-view;protectsleep/physicalplay.
●School-age:Don’tletmediadisplaceotherimportantactivitiessuchasqualitysleep,regularexercise,family
meals,“unplugged”downtime.

31. Autism
SaudiClinicalPreventiveGuideline:
●[U6]Universalscreeningat18mand24m(validatedtool).
AAP:allchildrenshouldbescreenedspecificallyforAutismSpectrumDisorderduringregularwell-childdoctorvisits
at:18monthsand24monthswithvalidatedtools(e.g.M-CHAT-R/F)
M-CHAT-R/F tool (20 Items):
Score:Yes = 0, No = 1 (concern = 1).
Reverse-scored items: #2, #5, #12 → Yes = 1, No = 0.
Risk & next steps
0–2(Low risk): Negative. If <24 months, rescreen at 24 m.
3–7(Moderate): Do Follow-Up Interview on elevated items. If Follow-Up score ≥2 → Positive → refer (EI + diagnostic).
8–20(High): Positive; bypass Follow-Up → immediate referral.
Red Flags In Child Development
2 months
No startle/response to loud soundsNo visual tracking/hand-following Poor head control on pull-to-sit
4 months
Can’t hold head up in prone Can’t track all directions Obvious squint/strabismus
6 months
Not sitting without support Not rolling both directions Doesn’t respond to name
9 months
Not sitting independently Doesn’t bear weight on legs No babbling (“mama/baba/dada”)
12 months
No pointing to share interestNo gestures (bye-bye, hi-five, salam) Regression: loses words/social skills
18 months
No single-word vocabulary ≥15 words Not walking independently Regression: loses words/social skills
24 months
Doesn’t follow simple commands<50 single words/ no two-word phrasesRegression: loses previously gained skills
Counselling
Developmental Delays & Disabilities
SaudiClinicalPreventiveGuideline:
●[U6]Universalsurveillance/screeningat9,18,30m(validatedtools).
AAP:recommendsthatallchildrenbescreenedfordevelopmentaldelaysanddisabilitiesduringregularwell-child
doctorvisitsat:-9months-18months-30months

32. Autism
SaudiClinicalPreventiveGuideline:
●[U6]Universalscreeningat18mand24m(validatedtool).
AAP:allchildrenshouldbescreenedspecificallyforAutismSpectrumDisorderduringregularwell-childdoctorvisits
at:18monthsand24monthswithvalidatedtools(e.g.M-CHAT-R/F)
M-CHAT-R/F tool (20 Items):
Score:Yes = 0, No = 1 (concern = 1).
Reverse-scored items: #2, #5, #12 → Yes = 1, No = 0.
Risk & next steps
0–2(Low risk): Negative. If <24 months, rescreen at 24 m.
3–7(Moderate): Do Follow-Up Interview on elevated items. If Follow-Up score ≥2 → Positive → refer (EI + diagnostic).
8–20(High): Positive; bypass Follow-Up → immediate referral.
Red Flags In Child Development
2 months
No startle/response to loud soundsNo visual tracking/hand-following Poor head control on pull-to-sit
4 months
Can’t hold head up in prone Can’t track all directions Obvious squint/strabismus
6 months
Not sitting without support Not rolling both directions Doesn’t respond to name
9 months
Not sitting independently Doesn’t bear weight on legs No babbling (“mama/baba/dada”)
12 months
No pointing to share interestNo gestures (bye-bye, hi-five, salam) Regression: loses words/social skills
18 months
No single-word vocabulary ≥15 words Not walking independently Regression: loses words/social skills
24 months
Doesn’t follow simple commands<50 single words/ no two-word phrasesRegression: loses previously gained skills
M-CHAT-R Item
1 If you point at something across the room, does your child look at it? ☐NO ☐YES
2* Have you ever wondered if your child might be deaf? ☐NO ☐YES
3 Does your child play pretend or make-believe? ☐NO ☐YES
4 Does your child like climbing on things? ☐NO ☐YES
5* Does your child make unusual finger movements near his or her eyes? ☐NO ☐YES
6 Does your child point with one finger to ask for something or to get help? ☐NO ☐YES
7 Does your child point with one finger to show you something interesting? ☐NO ☐YES
8 Is your child interested in other children? ☐NO ☐YES
9 Does your child show you things by bringing them to you or holding them up for you to see —not to get help, but just to share?☐NO ☐YES
10 Does your child respond when you call his or her name? ☐NO ☐YES
11 When you smile at your child, does he or she smile back at you? ☐NO ☐YES
12*Does your child get upset by everyday noises? ☐NO ☐YES
13 Does your child walk? ☐NO ☐YES
14 Does your child look you in the eye when you are talking to him or her, playing with him or her, or dressing him or her?☐NO ☐YES
15 Does your child try to copy what you do? ☐NO ☐YES
16 If you turn your head to look at something, does your child look around to see what you are looking at? ☐NO ☐YES
17 Does your child try to get you to watch him or her? ☐NO ☐YES
18 Does your child understand when you tell him or her to do something? ☐NO ☐YES
19 If something new happens, does your child look at your face to see how you feel about it? ☐NO ☐YES
20 Does your child like movement activities? ☐NO ☐YES
Counselling

33. Behavioral Counseling for Obesity
SaudiClinicalPreventiveGuideline:
●[18–59]B—Offer/referralif>30BMItointensive,multicomponentprograms.
USPSTF:B(Jun2024):Intensivelifestyleprograms
Autism
SaudiClinicalPreventiveGuideline:
●[U6]Universalscreeningat18mand24m(validatedtool).
AAP:allchildrenshouldbescreenedspecificallyforAutismSpectrumDisorderduringregularwell-childdoctorvisits
at:18monthsand24monthswithvalidatedtools(e.g.M-CHAT-R/F)
M-CHAT-R/F tool (20 Items):
Score:Yes = 0, No = 1 (concern = 1).
Reverse-scored items: #2, #5, #12 → Yes = 1, No = 0.
Risk & next steps
0–2(Low risk): Negative. If <24 months, rescreen at 24 m.
3–7(Moderate): Do Follow-Up Interview on elevated items. If Follow-Up score ≥2 → Positive → refer (EI + diagnostic).
8–20(High): Positive; bypass Follow-Up → immediate referral.
M-CHAT-R Item
1 If you point at something across the room, does your child look at it? ☐NO ☐YES
2* Have you ever wondered if your child might be deaf? ☐NO ☐YES
3 Does your child play pretend or make-believe? ☐NO ☐YES
4 Does your child like climbing on things? ☐NO ☐YES
5* Does your child make unusual finger movements near his or her eyes? ☐NO ☐YES
6 Does your child point with one finger to ask for something or to get help? ☐NO ☐YES
7 Does your child point with one finger to show you something interesting? ☐NO ☐YES
8 Is your child interested in other children? ☐NO ☐YES
9 Does your child show you things by bringing them to you or holding them up for you to see —not to get help, but just to share?☐NO ☐YES
10 Does your child respond when you call his or her name? ☐NO ☐YES
11 When you smile at your child, does he or she smile back at you? ☐NO ☐YES
12*Does your child get upset by everyday noises? ☐NO ☐YES
13 Does your child walk? ☐NO ☐YES
14 Does your child look you in the eye when you are talking to him or her, playing with him or her, or dressing him or her?☐NO ☐YES
15 Does your child try to copy what you do? ☐NO ☐YES
16 If you turn your head to look at something, does your child look around to see what you are looking at? ☐NO ☐YES
17 Does your child try to get you to watch him or her? ☐NO ☐YES
18 Does your child understand when you tell him or her to do something? ☐NO ☐YES
19 If something new happens, does your child look at your face to see how you feel about it? ☐NO ☐YES
20 Does your child like movement activities? ☐NO ☐YES
Counselling

34. Falls Assessment & Physical Activity
SaudiClinicalPreventiveGuideline:
●[60+]B—for+65yFallsrisk(STEADI,TimedUp-and-Go),exercise/balancetraining;addressvision/meds/home
hazards.
USPSTF:B(Jun4,2024):Offerexerciseinterventionstocommunity-dwellingadults≥65atincreasedfallrisk
Behavioral Counseling for Obesity
SaudiClinicalPreventiveGuideline:
●[18–59]B—Offer/referralif>30BMItointensive,multicomponentprograms.
USPSTF:B(Jun2024):Intensivelifestyleprograms
Counselling
Autism
SaudiClinicalPreventiveGuideline:
●[U6]Universalscreeningat18mand24m(validatedtool).
AAP:allchildrenshouldbescreenedspecificallyforAutismSpectrumDisorderduringregularwell-childdoctorvisits
at:18monthsand24monthswithvalidatedtools(e.g.M-CHAT-R/F)
M-CHAT-R/F tool (20 Items):
Score:Yes = 0, No = 1 (concern = 1).
Reverse-scored items: #2, #5, #12 → Yes = 1, No = 0.
Risk & next steps
0–2(Low risk): Negative. If <24 months, rescreen at 24 m.
3–7(Moderate): Do Follow-Up Interview on elevated items. If Follow-Up score ≥2 → Positive → refer (EI + diagnostic).
8–20(High): Positive; bypass Follow-Up → immediate referral.
M-CHAT-R Item
1 If you point at something across the room, does your child look at it? ☐NO ☐YES
2* Have you ever wondered if your child might be deaf? ☐NO ☐YES
3 Does your child play pretend or make-believe? ☐NO ☐YES
4 Does your child like climbing on things? ☐NO ☐YES
5* Does your child make unusual finger movements near his or her eyes? ☐NO ☐YES
6 Does your child point with one finger to ask for something or to get help? ☐NO ☐YES
7 Does your child point with one finger to show you something interesting? ☐NO ☐YES
8 Is your child interested in other children? ☐NO ☐YES
9 Does your child show you things by bringing them to you or holding them up for you to see —not to get help, but just to share?☐NO ☐YES
10 Does your child respond when you call his or her name? ☐NO ☐YES
11 When you smile at your child, does he or she smile back at you? ☐NO ☐YES
12*Does your child get upset by everyday noises? ☐NO ☐YES
13 Does your child walk? ☐NO ☐YES
14 Does your child look you in the eye when you are talking to him or her, playing with him or her, or dressing him or her?☐NO ☐YES
15 Does your child try to copy what you do? ☐NO ☐YES
16 If you turn your head to look at something, does your child look around to see what you are looking at? ☐NO ☐YES
17 Does your child try to get you to watch him or her? ☐NO ☐YES
18 Does your child understand when you tell him or her to do something? ☐NO ☐YES
19 If something new happens, does your child look at your face to see how you feel about it? ☐NO ☐YES
20 Does your child like movement activities? ☐NO ☐YES

35. STEADI:
Ask3questions:
●Anyfallsinpastyear?
●Feelunsteadystanding/walking?
●Worriedaboutfalling?
Yestoany,Proceedtogait/balancetesting
Falls Assessment & Physical Activity
SaudiClinicalPreventiveGuideline:
●[60+]B—for+65yFallsrisk(STEADI,TimedUp-and-Go),exercise/balancetraining;addressvision/meds/home
hazards.
USPSTF:B(Jun4,2024):Offerexerciseinterventionstocommunity-dwellingadults≥65atincreasedfallrisk
Counselling
Behavioral Counseling for Obesity
SaudiClinicalPreventiveGuideline:
●[18–59]B—Offer/referralif>30BMItointensive,multicomponentprograms.
USPSTF:B(Jun2024):Intensivelifestyleprograms

36. Dementia
SaudiClinicalPreventiveGuideline:
●[60+]Assessifpatient/family/clinicianhasconcerns.
NICE:screenonlywhendementiaissuspectedafterhistory/exam.Useabriefvalidatedtool(e.g.,Mini-Cog,MIS)
CTFPHC(Canada):strongrecommendationagainstinstrument-basedscreeningofasymptomaticadults≥65for
Cognitiveimpairment(2024).
Falls Assessment & Physical Activity
STEADI:
Ask3questions:
●Anyfallsinpastyear?
●Feelunsteadystanding/walking?
●Worriedaboutfalling?
Yestoany,Proceedtogait/balancetesting
Counselling
SaudiClinicalPreventiveGuideline:
●[60+]B—for+65yFallsrisk(STEADI,TimedUp-and-Go),exercise/balancetraining;addressvision/meds/home
hazards.
USPSTF:B(Jun4,2024):Offerexerciseinterventionstocommunity-dwellingadults≥65atincreasedfallrisk

37. Blood Pressure Measurement
SaudiClinicalPreventiveGuideline:
●[18–59]A—Screen≥18y;confirmelevationswithHBPM/ABPM;q1–3y(everyvisitifrisks).
●[60+]B—Yearly;confirmout-of-officebeforetreatment.
Dementia
SaudiClinicalPreventiveGuideline:
●[60+]Assessifpatient/family/clinicianhasconcerns.
NICE:screenonlywhendementiaissuspectedafterhistory/exam.Useabriefvalidatedtool(e.g.,Mini-Cog,MIS)
CTFPHC(Canada):strongrecommendationagainstinstrument-basedscreeningofasymptomaticadults≥65for
Cognitiveimpairment(2024).
Counselling
Falls Assessment & Physical Activity
STEADI:
Ask3questions:
●Anyfallsinpastyear?
●Feelunsteadystanding/walking?
●Worriedaboutfalling?
Yestoany,Proceedtogait/balancetesting
Clinical
Examination
.

38. Dementia
SaudiClinicalPreventiveGuideline:
●[60+]Assessifpatient/family/clinicianhasconcerns.
NICE:screenonlywhendementiaissuspectedafterhistory/exam.Useabriefvalidatedtool(e.g.,Mini-Cog,MIS)
CTFPHC(Canada):strongrecommendationagainstinstrument-basedscreeningofasymptomaticadults≥65for
Cognitiveimpairment(2024).
Blood Pressure Measurement
SaudiClinicalPreventiveGuideline:
●[18–59]A—Screen≥18y;confirmelevationswithHBPM/ABPM;q1–3y(everyvisitifrisks).
●[60+]B—Yearly;confirmout-of-officebeforetreatment.
Clinical
Examination
.
Counselling

39. Mouth & Dental Examination
SaudiClinicalPreventiveGuideline:
●[U6]B—Dentalreferralfrom12mthenyearly;applyfluoridevarnishfromfirsttoothto<5y.
●[6–17][18–59]Inspectteeth/gums/mucosaforcaries,lesions,gingivitis,erosion;orthoneeds;annual.
Blood Pressure Measurement
SaudiClinicalPreventiveGuideline:
●[18–59]A—Screen≥18y;confirmelevationswithHBPM/ABPM;q1–3y(everyvisitifrisks).
●[60+]B—Yearly;confirmout-of-officebeforetreatment.
Clinical Examination

40. Growth Parameters
SaudiClinicalPreventiveGuideline:
●[U6]Plotonage/sexcharts;addBMI-for-agefrom2y.
●[6–17]B—AnnualBMI(obesity≥95th%ile)ifobeseand≥6y,refertointensive,family-basedprograms
●[18–59]BMI&waistatintakeandatleastq2y(manyclinicseveryvisit)usetotriggerlifestyleorprogramreferral.
●[60+]BMIeachvisit;counselactivity/nutrition.
USPSTF:Children/adolescentswithhighBMI—refertointensiveinterventionsB(Jun2024);HighBMI(≥95th%ile)
interventionsB(Jun2024)
Mouth & Dental Examination
SaudiClinicalPreventiveGuideline:
●[U6]B—Dentalreferralfrom12mthenyearly;applyfluoridevarnishfromfirsttoothto<5y.
●[6–17][18–59]Inspectteeth/gums/mucosaforcaries,lesions,gingivitis,erosion;orthoneeds;annual.
Clinical Examination
Blood Pressure Measurement
SaudiClinicalPreventiveGuideline:
●[18–59]A—Screen≥18y;confirmelevationswithHBPM/ABPM;q1–3y(everyvisitifrisks).
●[60+]B—Yearly;confirmout-of-officebeforetreatment.

41. Children Specific Examinations
SaudiClinicalPreventiveGuideline:
Developmentalmilestones:
●[U6]Usevalidatedtools(e.g.,Denverupto6y);documentateachWCC.
Fontanel:
●[U6]PosteriorfontanelTypicallyclosedby~2m.
●[U6]AnteriorfontanelTypicallycloses10–24m(laterifpremature).
Visionscreening:
●[U6]B—Redreflexeveryinfantcheck;abnormal/unequal/absent⇒urgentreferral.
●[U6]Corneallightreflex/Hirschberg—esotropia>2morexotropia>6m→refer.
●[U6]B—Cover–uncoverfrom~3y(cooperativechild).
●[U6]Visualacuity(Snellen)whencooperative(~3–5y).
Growth Parameters
SaudiClinicalPreventiveGuideline:
●[U6]Plotonage/sexcharts;addBMI-for-agefrom2y.
●[6–17]B—AnnualBMI(obesity≥95th%ile)ifobeseand≥6y,refertointensive,family-basedprograms
●[18–59]BMI&waistatintakeandatleastq2y(manyclinicseveryvisit)usetotriggerlifestyleorprogramreferral.
●[60+]BMIeachvisit;counselactivity/nutrition.
USPSTF:Children/adolescentswithhighBMI—refertointensiveinterventionsB(Jun2024);HighBMI(≥95th%ile)
interventionsB(Jun2024)
Clinical Examination
Mouth & Dental Examination
SaudiClinicalPreventiveGuideline:
●[U6]B—Dentalreferralfrom12mthenyearly;applyfluoridevarnishfromfirsttoothto<5y.
●[6–17][18–59]Inspectteeth/gums/mucosaforcaries,lesions,gingivitis,erosion;orthoneeds;annual.

42. SaudiClinicalPreventiveGuideline:
Ears/hearingscreening:
●[U6]B—Observeresponses;whispertestinolderchild;standardizedaudiometry/referral~3yifconcerns.
SystemReview:
●[U6]SystemreviewforCVS/Abdomen/Hernia/Genitalia-circumcision/Lowerlimbs/SkinateachWCC;
documentfindingsandparentalconcerns
Screeningfordevelopmentaldysplasiaofthehip(DDH):
●[U6]Newbornhips:Barlow&Ortolani;referifabnormal.
Children Specific Examinations
SaudiClinicalPreventiveGuideline:
Developmentalmilestones:
●[U6]Usevalidatedtools(e.g.,Denverupto6y);documentateachWCC.
Fontanel:
●[U6]PosteriorfontanelTypicallyclosedby~2m.
●[U6]AnteriorfontanelTypicallycloses10–24m(laterifpremature).
Visionscreening:
●[U6]B—Redreflexeveryinfantcheck;abnormal/unequal/absent⇒urgentreferral.
●[U6]Corneallightreflex/Hirschberg—esotropia>2morexotropia>6m→refer.
●[U6]B—Cover–uncoverfrom~3y(cooperativechild).
●[U6]Visualacuity(Snellen)whencooperative(~3–5y).
Clinical Examination
Growth Parameters
SaudiClinicalPreventiveGuideline:
●[U6]Plotonage/sexcharts;addBMI-for-agefrom2y.
●[6–17]B—AnnualBMI(obesity≥95th%ile)ifobeseand≥6y,refertointensive,family-basedprograms
●[18–59]BMI&waistatintakeandatleastq2y(manyclinicseveryvisit)usetotriggerlifestyleorprogramreferral.
●[60+]BMIeachvisit;counselactivity/nutrition.
USPSTF:Children/adolescentswithhighBMI—refertointensiveinterventionsB(Jun2024);HighBMI(≥95th%ile)
interventionsB(Jun2024)

43. Newborn Labs
SaudiClinicalPreventiveGuideline:
●[U6]A*—ABO/Rh(asindicated);CBC(risk/sx).
●[U6]A*—Sicklecell(ifnotdoneatbirth(often~9m)).
●[U6]G6PDifnotdone.
●[U6]A*—PKU&TFT—NationalNewbornScreening.
Children Specific Examinations
SaudiClinicalPreventiveGuideline:
Ears/hearingscreening:
●[U6]B—Observeresponses;whispertestinolderchild;standardizedaudiometry/referral~3yifconcerns.
SystemReview:
●[U6]SystemreviewforCVS/Abdomen/Hernia/Genitalia-circumcision/Lowerlimbs/SkinateachWCC;
documentfindingsandparentalconcerns
Screeningfordevelopmentaldysplasiaofthehip(DDH):
●[U6]Newbornhips:Barlow&Ortolani;referifabnormal.
Clinical Examination
SaudiClinicalPreventiveGuideline:
Developmentalmilestones:
●[U6]Usevalidatedtools(e.g.,Denverupto6y);documentateachWCC.
Fontanel:
●[U6]PosteriorfontanelTypicallyclosedby~2m.
●[U6]AnteriorfontanelTypicallycloses10–24m(laterifpremature).
Visionscreening:
●[U6]B—Redreflexeveryinfantcheck;abnormal/unequal/absent⇒urgentreferral.
●[U6]Corneallightreflex/Hirschberg—esotropia>2morexotropia>6m→refer.
●[U6]B—Cover–uncoverfrom~3y(cooperativechild).
●[U6]Visualacuity(Snellen)whencooperative(~3–5y).
Labs &Tests
.

44. Newborn Labs
SaudiClinicalPreventiveGuideline:
●[U6]A*—ABO/Rh(asindicated);CBC(risk/sx).
●[U6]A*—Sicklecell(ifnotdoneatbirth(often~9m)).
●[U6]G6PDifnotdone.
●[U6]A*—PKU&TFT—NationalNewbornScreening.
Children Specific Examinations
SaudiClinicalPreventiveGuideline:
Ears/hearingscreening:
●[U6]B—Observeresponses;whispertestinolderchild;standardizedaudiometry/referral~3yifconcerns.
SystemReview:
●[U6]SystemreviewforCVS/Abdomen/Hernia/Genitalia-circumcision/Lowerlimbs/SkinateachWCC;
documentfindingsandparentalconcerns
Screeningfordevelopmentaldysplasiaofthehip(DDH):
●[U6]Newbornhips:Barlow&Ortolani;referifabnormal.
Labs &Tests
.
Clinical Examination

45. STIs
SaudiClinicalPreventiveGuideline:
HIV:
●[6–17]A—atleastonce≥15y;earlierifrisk.
●[18–59]A—once,thenperrisk
Chlamydia/Gonorrhea:
●[6–17]B—annualsexuallyactivefemales<25;considerhigh-riskmales.
●[18–59]B—perrisk/age
Syphilis(2025):
●[18–59]A—ifpregnancyoratrisk
Newborn Labs
SaudiClinicalPreventiveGuideline:
●[U6]A*—ABO/Rh(asindicated);CBC(risk/sx).
●[U6]A*—Sicklecell(ifnotdoneatbirth(often~9m)).
●[U6]G6PDifnotdone.
●[U6]A*—PKU&TFT—NationalNewbornScreening.
Labs & Tests

46. Hepatitis
SaudiClinicalPreventiveGuideline:
HBV:
●[6–17]B—risk-basedtesting.
●[18–59]B—screenatrisk(somedoone-timeuniversal).
HCV:
●[6–17]B—risk-basedtesting.
●[18–59]B—one-time18–79(repeatifrisk).
STIs
SaudiClinicalPreventiveGuideline:
HIV:
●[6–17]A—atleastonce≥15y;earlierifrisk.
●[18–59]A—once,thenperrisk
Chlamydia/Gonorrhea:
●[6–17]B—annualsexuallyactivefemales<25;considerhigh-riskmales.
●[18–59]B—perrisk/age
Syphilis(2025):
●[18–59]A—ifpregnancyoratrisk
Labs & Tests
Newborn Labs
SaudiClinicalPreventiveGuideline:
●[U6]A*—ABO/Rh(asindicated);CBC(risk/sx).
●[U6]A*—Sicklecell(ifnotdoneatbirth(often~9m)).
●[U6]G6PDifnotdone.
●[U6]A*—PKU&TFT—NationalNewbornScreening.

47. Diabetes
SaudiClinicalPreventiveGuideline:
●[18–59]B—35–70ywithoverweight/obesity(earlierifhigh-risk);q3yifnormal.
●[60+]B—manyqualifyviarisk;A1C/FPGq3y(q1yifpreDM).
Hepatitis
SaudiClinicalPreventiveGuideline:
HBV:
●[6–17]B—risk-basedtesting.
●[18–59]B—screenatrisk(somedoone-timeuniversal).
HCV:
●[6–17]B—risk-basedtesting.
●[18–59]B—one-time18–79(repeatifrisk).
Labs & Tests
STIs
SaudiClinicalPreventiveGuideline:
HIV:
●[6–17]A—atleastonce≥15y;earlierifrisk.
●[18–59]A—once,thenperrisk
Chlamydia/Gonorrhea:
●[6–17]B—annualsexuallyactivefemales<25;considerhigh-riskmales.
●[18–59]B—perrisk/age
Syphilis(2025):
●[18–59]A—ifpregnancyoratrisk

48. Lipids
SaudiClinicalPreventiveGuideline:
●[18–59]B—paneltoguideASCVDrisk;q4–6y(q1–3yontherapy).
●[60+]B—paneltoguideASCVDrisk;q4–6y(q1–3yontherapy).
Diabetes
SaudiClinicalPreventiveGuideline:
●[18–59]B—35–70ywithoverweight/obesity(earlierifhigh-risk);q3yifnormal.
●[60+]B—manyqualifyviarisk;A1C/FPGq3y(q1yifpreDM).
Labs & Tests
Hepatitis
SaudiClinicalPreventiveGuideline:
HBV:
●[6–17]B—risk-basedtesting.
●[18–59]B—screenatrisk(somedoone-timeuniversal).
HCV:
●[6–17]B—risk-basedtesting.
●[18–59]B—one-time18–79(repeatifrisk).

49. Abdominal Aortic Aneurysm
SaudiClinicalPreventiveGuideline:
●[60+]B—One-timeUSinmen65–75whoeversmoked.
Lipids
SaudiClinicalPreventiveGuideline:
●[18–59]B—paneltoguideASCVDrisk;q4–6y(q1–3yontherapy).
●[60+]B—paneltoguideASCVDrisk;q4–6y(q1–3yontherapy).
Labs & Tests
Diabetes
SaudiClinicalPreventiveGuideline:
●[18–59]B—35–70ywithoverweight/obesity(earlierifhigh-risk);q3yifnormal.
●[60+]B—manyqualifyviarisk;A1C/FPGq3y(q1yifpreDM).

50. Osteoporosis
SaudiClinicalPreventiveGuideline:
●[18–59][60+]B—women≥65oryoungerwithhighFRAX;DEXAq2–5y.
USPSTF:Women≥65B(Jan2025);postmenopausal<65withriskB(Jan2025).
Abdominal Aortic Aneurysm
SaudiClinicalPreventiveGuideline:
●[60+]B—One-timeUSinmen65–75whoeversmoked.
Labs & Tests
Lipids
SaudiClinicalPreventiveGuideline:
●[18–59]B—paneltoguideASCVDrisk;q4–6y(q1–3yontherapy).
●[60+]B—paneltoguideASCVDrisk;q4–6y(q1–3yontherapy).

51. Cancer Screening
SaudiClinicalPreventiveGuideline:
Cervicalcancer(Papsmear)
●[18–59]A—21–29cytologyq3y;30–65hrHPVq5yorcytologyq3yorco-testq5y.
BreastCancer(Mammogram)(2024)
●[18–59][60+]B—mammogramq2y(40–74).
LungCancer
●[18–59][60+]B—annualLDCT50–80y,≥20pack-years,currentorquit<15y.
ColonCancer(FOBT/FIT/FIT-DNA/sig/CTC/colonoscopy)
●[18–59][60+]45–75y(A50–75;B45–49):FITq1y,FIT-DNAq1–3y,sigq5y,CT-colonographyq5y,colonoscopy
q10y.
Osteoporosis
SaudiClinicalPreventiveGuideline:
●[18–59][60+]B—women≥65oryoungerwithhighFRAX;DEXAq2–5y.
USPSTF:Women≥65B(Jan2025);postmenopausal<65withriskB(Jan2025).
Labs & Tests
Abdominal Aortic Aneurysm
SaudiClinicalPreventiveGuideline:
●[60+]B—One-timeUSinmen65–75whoeversmoked.

52. Fluoride
SaudiClinicalPreventiveGuideline:
●[U6]B—supplementifwaterlow;varnishfromfirsttoothto<5y.
●[6–17]Supplementonlyifwaterlowandhighcariesrisk.
Cancer Screening
SaudiClinicalPreventiveGuideline:
Cervicalcancer(Papsmear)
●[18–59]A—21–29cytologyq3y;30–65hrHPVq5yorcytologyq3yorco-testq5y.
BreastCancer(Mammogram)(2024)
●[18–59][60+]B—mammogramq2y(40–74).
LungCancer
●[18–59][60+]B—annualLDCT50–80y,≥20pack-years,currentorquit<15y.
ColonCancer(FOBT/FIT/FIT-DNA/sig/CTC/colonoscopy)
●[18–59][60+]45–75y(A50–75;B45–49):FITq1y,FIT-DNAq1–3y,sigq5y,CT-colonographyq5y,colonoscopy
q10y.
Labs & Tests
Osteoporosis
SaudiClinicalPreventiveGuideline:
●[18–59][60+]B—women≥65oryoungerwithhighFRAX;DEXAq2–5y.
USPSTF:Women≥65B(Jan2025);postmenopausal<65withriskB(Jan2025).
Medications
.

53. Fluoride
SaudiClinicalPreventiveGuideline:
●[U6]B—supplementifwaterlow;varnishfromfirsttoothto<5y.
●[6–17]Supplementonlyifwaterlowandhighcariesrisk.
Cancer Screening
SaudiClinicalPreventiveGuideline:
Cervicalcancer(Papsmear)
●[18–59]A—21–29cytologyq3y;30–65hrHPVq5yorcytologyq3yorco-testq5y.
BreastCancer(Mammogram)(2024)
●[18–59][60+]B—mammogramq2y(40–74).
LungCancer
●[18–59][60+]B—annualLDCT50–80y,≥20pack-years,currentorquit<15y.
ColonCancer(FOBT/FIT/FIT-DNA/sig/CTC/colonoscopy)
●[18–59][60+]45–75y(A50–75;B45–49):FITq1y,FIT-DNAq1–3y,sigq5y,CT-colonographyq5y,colonoscopy
q10y.
Medications
.
Labs & Tests

54. Vitamin D
SaudiClinicalPreventiveGuideline:
●[U6]400IU/dinfancy→600IU/d≥1y(until≥1L/dwholemilk).
●[60+]Donotuseforroutinefracture/fallpreventionwithoutdeficiency;test/treatonlyifindicated.
Fluoride
SaudiClinicalPreventiveGuideline:
●[U6]B—supplementifwaterlow;varnishfromfirsttoothto<5y.
●[6–17]Supplementonlyifwaterlowandhighcariesrisk.
Medications

55. Iron
SaudiClinicalPreventiveGuideline:
●[U6]ExclusivelyBreastFeeding:1mg/kg/dfrom4muntiliron-richfoodsisintroduced;formulausuallyadequate.
Vitamin D
SaudiClinicalPreventiveGuideline:
●[U6]400IU/dinfancy→600IU/d≥1y(until≥1L/dwholemilk).
●[60+]Donotuseforroutinefracture/fallpreventionwithoutdeficiency;test/treatonlyifindicated.
Medications
Fluoride
SaudiClinicalPreventiveGuideline:
●[U6]B—supplementifwaterlow;varnishfromfirsttoothto<5y.
●[6–17]Supplementonlyifwaterlowandhighcariesrisk.

56. Folic Acid
SaudiClinicalPreventiveGuideline:
●[6–17][18–59]A—Femaleswhocanbecomepregnant:0.4–0.8mg/dstarting≥1mopre-conceptionthrough1st
trimester(4mg/difpriorNTD/certainAEDs/PGDM).
Iron
SaudiClinicalPreventiveGuideline:
●[U6]ExclusivelyBreastFeeding:1mg/kg/dfrom4muntiliron-richfoodsisintroduced;formulausuallyadequate.
Medications
Vitamin D
SaudiClinicalPreventiveGuideline:
●[U6]400IU/dinfancy→600IU/d≥1y(until≥1L/dwholemilk).
●[60+]Donotuseforroutinefracture/fallpreventionwithoutdeficiency;test/treatonlyifindicated.

57. Statins
SaudiClinicalPreventiveGuideline:
●[18–59]B/C—startif40–75ywithriskfactorsand10-yrASCVD≥10%(B)orselectivelyat7.5–<10%(C);lipid
checks4–12wafterchanges,thenq3–12mo.
●[60+]Evidenceinsufficient≥76ytostart;continueifalreadyindicated.
Folic Acid
SaudiClinicalPreventiveGuideline:
●[6–17][18–59]A—Femaleswhocanbecomepregnant:0.4–0.8mg/dstarting≥1mopre-conceptionthrough1st
trimester(4mg/difpriorNTD/certainAEDs/PGDM).
Medications
Iron
SaudiClinicalPreventiveGuideline:
●[U6]ExclusivelyBreastFeeding:1mg/kg/dfrom4muntiliron-richfoodsisintroduced;formulausuallyadequate.

58. Aspirin (primary prevention)
SaudiClinicalPreventiveGuideline:
●[18–59]C—consider40–59ywith≥10%10-yrASCVDrisk(shareddecision);donotinitiate≥60y.
Statins
SaudiClinicalPreventiveGuideline:
●[18–59]B/C—startif40–75ywithriskfactorsand10-yrASCVD≥10%(B)orselectivelyat7.5–<10%(C);lipid
checks4–12wafterchanges,thenq3–12mo.
●[60+]Evidenceinsufficient≥76ytostart;continueifalreadyindicated.
Medications
Folic Acid
SaudiClinicalPreventiveGuideline:
●[6–17][18–59]A—Femaleswhocanbecomepregnant:0.4–0.8mg/dstarting≥1mopre-conceptionthrough1st
trimester(4mg/difpriorNTD/certainAEDs/PGDM).

59. Birth Medications
SaudiClinicalPreventiveGuideline:
VitaminK
●[U6]1mgIM(ororalregimen)atbirth.
Erythromycineyeointment
●[U6]A—singleneonataldoseforgonococcalprophylaxis.
Aspirin (primary prevention)
SaudiClinicalPreventiveGuideline:
●[18–59]C—consider40–59ywith≥10%10-yrASCVDrisk(shareddecision);donotinitiate≥60y.
Medications
Statins
SaudiClinicalPreventiveGuideline:
●[18–59]B/C—startif40–75ywithriskfactorsand10-yrASCVD≥10%(B)orselectivelyat7.5–<10%(C);lipid
checks4–12wafterchanges,thenq3–12mo.
●[60+]Evidenceinsufficient≥76ytostart;continueifalreadyindicated.

60. Routine Vaccination
Birth 2 mos 4 mos 6 mos 9 mos 12 mos 18 mos 24 mos 4–6 yrs 11 yrs 12 yrs 18 yrs
BCG Tdap
HepB HepB HepB HepB
RV RV RV
DTaP DTaP DTaP DTaP DTaP
Hib Hib Hib Hib
PCV PCV PCV PCV
IPV IPV IPV
OPV OPV OPV OPV
Measles
MCV4 MCV4 MCV4
HepA HepA
Varicella Varicella
HPV* HPV*
MMR MMR MMR
Influenza
Birth Medications
SaudiClinicalPreventiveGuideline:
VitaminK
●[U6]1mgIM(ororalregimen)atbirth.
Erythromycineyeointment
●[U6]A—singleneonataldoseforgonococcalprophylaxis.
Medications
Aspirin (primary prevention)
SaudiClinicalPreventiveGuideline:
●[18–59]C—consider40–59ywith≥10%10-yrASCVDrisk(shareddecision);donotinitiate≥60y.
Immunizations
.

61. Routine Vaccination
Birth 2 mos 4 mos 6 mos 9 mos 12 mos 18 mos 24 mos 4–6 yrs 11 yrs 12 yrs 18 yrs
BCG Tdap
HepB HepB HepB HepB
RV RV RV
DTaP DTaP DTaP DTaP DTaP
Hib Hib Hib Hib
PCV PCV PCV PCV
IPV IPV IPV
OPV OPV OPV OPV
Measles
MCV4 MCV4 MCV4
HepA HepA
Varicella Varicella
HPV* HPV*
MMR MMR MMR
Influenza
Birth Medications
SaudiClinicalPreventiveGuideline:
VitaminK
●[U6]1mgIM(ororalregimen)atbirth.
Erythromycineyeointment
●[U6]A—singleneonataldoseforgonococcalprophylaxis.Immunizations
.
Medications

62. Catch-up Vaccination
SaudiMOH:
Routine Vaccination
Birth 2 mos 4 mos 6 mos 9 mos 12 mos 18 mos 24 mos 4–6 yrs 11 yrs 12 yrs 18 yrs
BCG Tdap
HepB HepB HepB HepB
RV RV RV
DTaP DTaP DTaP DTaP DTaP
Hib Hib Hib Hib
PCV PCV PCV PCV
IPV IPV IPV
OPV OPV OPV OPV
Measles
MCV4 MCV4 MCV4
HepA HepA
Varicella Varicella
HPV* HPV*
MMR MMR MMR
Influenza
Immunizations

63. Catch-up Vaccination
SaudiMOH:
Vaccine Routine 1st dose Catch-up min start
Hepatitis B (HepB) Birth Birth (<19y)
Rotavirus (oral, live) 2 m ≥6w (1st dose ≤15w)
DTaP 2 m ≥6w (If >7y, switch to Td)
Hib 2 m ≥6w (healthy >5y: none)
PCV13 2 m ≥6w (healthy >5y: none)
IPV 2 m ≥6w
BCG 6 m 6–12m (After >12m: only if high risk )
Measles (monovalent, live) 9 m 9m (After ≥12m use MMR)
MMR (live) 12 m ≥12m
Varicella (live) 12 m ≥12m
Hepatitis A 18 m ≥12m
MenACWY(MenACWY-D) 9 m ≥9m
Immunizations
Routine Vaccination
Birth 2 mos 4 mos 6 mos 9 mos 12 mos 18 mos 24 mos 4–6 yrs 11 yrs 12 yrs 18 yrs
BCG Tdap
HepB HepB HepB HepB
RV RV RV
DTaP DTaP DTaP DTaP DTaP
Hib Hib Hib Hib
PCV PCV PCV PCV
IPV IPV IPV
OPV OPV OPV OPV
Measles
MCV4 MCV4 MCV4
HepA HepA
Varicella Varicella
HPV* HPV*
MMR MMR MMR
Influenza

64. Adults Vaccination
Influenza:
●6mo–8y:if1sttimeshouldget2doses≥4weeksapart;otherwise1dose,
●≥9y:1doseAnnually(preferredinSeptember–October).
Tdap/Td:
●One-timeTdap,thenTd/Tdapq10y;woundboostersPRN.
●Eachpregnancy27–36w.
MMR:
●≥181–2dosesifnon-immune
●Ifbornafter1957andnon-immune,vaccinate.
Varicella:
●Giveonlyifnon-immune.
Catch-up Vaccination
SaudiMOH:
Vaccine Routine 1st dose Catch-up min start
Hepatitis B (HepB) Birth Birth (<19y)
Rotavirus (oral, live) 2 m ≥6w (1st dose ≤15w)
DTaP 2 m ≥6w (If >7y, switch to Td)
Hib 2 m ≥6w (healthy >5y: none)
PCV13 2 m ≥6w (healthy >5y: none)
IPV 2 m ≥6w
BCG 6 m 6–12m (After >12m: only if high risk )
Measles (monovalent, live) 9 m 9m (After ≥12m use MMR)
MMR (live) 12 m ≥12m
Varicella (live) 12 m ≥12m
Hepatitis A 18 m ≥12m
MenACWY(MenACWY-D) 9 m ≥9m
Immunizations

65. Zoster(Shingrix):
●2doses(0,2–6m)startingat≥50y.
HPV:
●Start11–12y(maystart9).Ifstart9–14→2doses(0,6–12m);if≥15→3doses(0,1–2,6m).
●Catch-upto26y;27–45yshareddecision-making.
Pneumococcal(PCV/PPSV23):
●Risk-based(asplenia,CSFleak,cochlearimplant,immunocompromise).
●At≥65:PCV20onceorPCV15→PPSV23(≥1ylater);adjustifpreviouslyvaccinated.
HepatitisA:
●Risk-based(travel,CLD,MSM,IDU).
HepatitisB:
●Universaladultseriesrecommended;consideranti-HBscheckinhigh-risk.
Adults Vaccination
Influenza:
●6mo–8y:if1sttimeshouldget2doses≥4weeksapart;otherwise1dose,
●≥9y:1doseAnnually(preferredinSeptember–October).
Tdap/Td:
●One-timeTdap,thenTd/Tdapq10y;woundboostersPRN.
●Eachpregnancy27–36w.
MMR:
●≥181–2dosesifnon-immune
●Ifbornafter1957andnon-immune,vaccinate.
Varicella:
●Giveonlyifnon-immune.
Immunizations
Catch-up Vaccination
SaudiMOH:
Vaccine Routine 1st dose Catch-up min start
Hepatitis B (HepB) Birth Birth (<19y)
Rotavirus (oral, live) 2 m ≥6w (1st dose ≤15w)
DTaP 2 m ≥6w (If >7y, switch to Td)
Hib 2 m ≥6w (healthy >5y: none)
PCV13 2 m ≥6w (healthy >5y: none)
IPV 2 m ≥6w
BCG 6 m 6–12m (After >12m: only if high risk )
Measles (monovalent, live) 9 m 9m (After ≥12m use MMR)
MMR (live) 12 m ≥12m
Varicella (live) 12 m ≥12m
Hepatitis A 18 m ≥12m
MenACWY(MenACWY-D) 9 m ≥9m

66. Meningococcal:
●Risk-based(Hajj,asplenia,complementdeficiency,labworkers,travelers,outbreaks).
Hib:
●Onlyforspecifichigh-riskchildren>5yandadults(e.g.,asplenia).
RSV:
●toall≥601doseevery2years,speciallyatrisk(immunocompromised,chronicdiseases)
Adults Vaccination
Zoster(Shingrix):
●2doses(0,2–6m)startingat≥50y.
HPV:
●Start11–12y(maystart9).Ifstart9–14→2doses(0,6–12m);if≥15→3doses(0,1–2,6m).
●Catch-upto26y;27–45yshareddecision-making.
Pneumococcal(PCV/PPSV23):
●Risk-based(asplenia,CSFleak,cochlearimplant,immunocompromise).
●At≥65:PCV20onceorPCV15→PPSV23(≥1ylater);adjustifpreviouslyvaccinated.
HepatitisA:
●Risk-based(travel,CLD,MSM,IDU).
HepatitisB:
●Universaladultseriesrecommended;consideranti-HBscheckinhigh-risk.
Immunizations
Influenza:
●6mo–8y:if1sttimeshouldget2doses≥4weeksapart;otherwise1dose,
●≥9y:1doseAnnually(preferredinSeptember–October).
Tdap/Td:
●One-timeTdap,thenTd/Tdapq10y;woundboostersPRN.
●Eachpregnancy27–36w.
MMR:
●≥181–2dosesifnon-immune
●Ifbornafter1957andnon-immune,vaccinate.
Varicella:
●Giveonlyifnon-immune.

67. Adults Vaccination
Meningococcal:
●Risk-based(Hajj,asplenia,complementdeficiency,labworkers,travelers,outbreaks).
Hib:
●Onlyforspecifichigh-riskchildren>5yandadults(e.g.,asplenia).
RSV:
●toall≥601doseevery2years,speciallyatrisk(immunocompromised,chronicdiseases)
Immunizations
Zoster(Shingrix):
●2doses(0,2–6m)startingat≥50y.
HPV:
●Start11–12y(maystart9).Ifstart9–14→2doses(0,6–12m);if≥15→3doses(0,1–2,6m).
●Catch-upto26y;27–45yshareddecision-making.
Pneumococcal(PCV/PPSV23):
●Risk-based(asplenia,CSFleak,cochlearimplant,immunocompromise).
●At≥65:PCV20onceorPCV15→PPSV23(≥1ylater);adjustifpreviouslyvaccinated.
HepatitisA:
●Risk-based(travel,CLD,MSM,IDU).
HepatitisB:
●Universaladultseriesrecommended;consideranti-HBscheckinhigh-risk.
| References |
USPSTFMOH AAFPSCG AAP

68. | References |
USPSTFMOH AAFPSCG AAP
Adults Vaccination
Meningococcal:
●Risk-based(Hajj,asplenia,complementdeficiency,labworkers,travelers,outbreaks).
Hib:
●Onlyforspecifichigh-riskchildren>5yandadults(e.g.,asplenia).
RSV:
●toall≥601doseevery2years,speciallyatrisk(immunocompromised,chronicdiseases)
Immunizations
Zoster(Shingrix):
●2doses(0,2–6m)startingat≥50y.
HPV:
●Start11–12y(maystart9).Ifstart9–14→2doses(0,6–12m);if≥15→3doses(0,1–2,6m).
●Catch-upto26y;27–45yshareddecision-making.
Pneumococcal(PCV/PPSV23):
●Risk-based(asplenia,CSFleak,cochlearimplant,immunocompromise).
●At≥65:PCV20onceorPCV15→PPSV23(≥1ylater);adjustifpreviouslyvaccinated.
HepatitisA:
●Risk-based(travel,CLD,MSM,IDU).
HepatitisB:
●Universaladultseriesrecommended;consideranti-HBscheckinhigh-risk.