Passport Health Plan’s mission is to improve the health and quality of life of our members. With this in mind, Passport Health Plan has adopted the enclosed Clinical Practice Guidelines. The intent of the guidelines is to support your efforts in the care and education of our members and to reduce variation in diagnosis and treatment.

The Plan makes every effort to ensure that current scientific data and expert opinion is the basis for each guideline. Each guideline is evaluated as new data becomes available or at a minimum of every two years. Passport Health Plan
monitors provider compliance and member outcomes related to these clinical guidelines for quality improvement initiatives and recredentialing efforts.

These guidelines are intended to assist the practitioner in clinical decision-making and attempt to define clinical practices that apply to most patients in most circumstances.

The treating practitioner should make the ultimate decision regarding the care of a particular patient. If you would like a hard copy of the guidelines, please contact the Quality Improvement nurse at (800) 578-0636, ext. 8259.

Acute Bronchitis

Acute Pharyngitis


Adult Obesity

Adult Preventive Health Clinical Practice Guidelines



Care of the Older Adult

Child & Adolescent Preventive Health Clinical Practice
Guidelines / EPSDT Periodicity Schedule

Child Obesity Clinical Practice Guidelines

Chronic Kidney Disease

Congestive Heart Failure (CHF)



EPSDT Interval Screening Calculator

Flu Vaccine

Lead Screening

Low Back Pain

Major Depressive Disorder

Management of High Blood Pressure in Adults


Otitis Media

Panic Disorder

Perinatal Care


Sickle Cell Disease

Substance Use Disorder

Use of Atypical Antipsychotic Medications in Children and Adolescents

Viral Upper Respiratory Infection VURI in Children