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At the initial assessment, it is important to determine the patient's stage of adolescence because each stage is associated with particular findings and challenges. A fundamental protocol at the initial visit is to discuss confidentiality with the patient and her parent. Ideally, a social history should be obtained from the patient alone by using the HEEADSSS format. Key features of the examination to include initially are menstrual history, assessment of weight and body mass index (assessed using growth charts for girls younger than 18 years old), blood pressure assessment (evaluated using appropriate normative tables), and developmental status (Tanner staging of breast and pubic hair development). Appropriate screening at an initial primary care visit includes vision screening, fasting lipid profile screening if the patient is 18–21 years old, and sexually-transmitted infection screening if the patient is sexually active. Vaccines should be updated according to the Advisory Committee on Immunization Practices recommendations.