The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

Appendix C - PBP_2008_screenshots_sec_b14

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

OMB: 0938-0763

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PBP 2008 Data Entry System Screens


Section B – 14a – Health Education and Wellness – Base 1 Screen


Section B – 14a – Health Education and Wellness – Base 2 Screen


Section B – 14a – Health Education and Wellness – Base 3 Screen


Section B – 14a – Health Education and Wellness – Base 4 Screen


Section B – 14a – Health Education and Wellness – Base 5 Screen


Section B – 14a – Health Education and Wellness – Base 6 Screen


Section B – 14a – Health Education and Wellness – Base 7 Screen


Section B – 14b – Immunizations – Base 1 Screen


Section B – 14b – Immunizations – Base 2 Screen


Section B – 14b – Immunizations – Base 3 Screen


Section B – 14c –Physical Exams – Base 1 Screen


Section B – 14c – Physical Exams – Base 2 Screen


Section B – 14c – Physical Exams – Base 3 Screen


Section B – 14c –Physical Exams – Base 4 Screen


Section B – 14d – Pap/Pelvic Exams – Base 1 Screen


Section B – 14d – Pap/Pelvic Exams – Base 2 Screen


Section B – 14d – Pap/Pelvic Exams – Base 3 Screen


Section B – 14d – Pap/Pelvic Exams – Base 4 Screen


Section B – 14d – Pap/Pelvic Exams – Base 5 Screen


Section B – 14e – Prostate Screening – Base 1 Screen


Section B – 14e – Prostate Screening – Base 2 Screen


Section B – 14e – Prostate Screening – Base 3 Screen


Section B – 14e – Prostate Screening – Base 4 Screen


Section B – 14f – Colorectal Screening – Base 1 Screen


Section B – 14f – Colorectal Screening – Base 2 Screen


Section B – 14f – Colorectal Screening – Base 3 Screen


Section B – 14f – Colorectal Screening – Base 4 Screen


Section B – 14f – Colorectal Screening – Base 5 Screen


Section B – 14g – Bone Mass Measurement – Base 1 Screen


Section B – 14g – Bone Mass Measurement – Base 2 Screen


Section B – 14g – Bone Mass Measurement – Base 3 Screen


Section B – 14h – Mammography – Base 1 Screen


Section B – 14h – Mammography – Base 2 Screen


Section B – 14h – Mammography – Base 3 Screen


Section B – 14h – Mammography – Base 4 Screen


Section B – 14i – Diabetes Monitoring – Base 1 Screen


Section B – 14i – Diabetes Monitoring – Base 2 Screen


Section B – 14i – Diabetes Monitoring – Base 3 Screen

Section B – 14J – Nutrition Therapy for Diabetes and Renal Disease – Base 1 Screen


Section B –14J – Nutrition Therapy for Diabetes and Renal Disease – Base 2 Screen


Section B –14J – Nutrition Therapy for Diabetes and Renal Disease – Base 3 Screen



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