The CCS Preventive Care & Discharge Cheat Sheet (2026)

Ask any resident who scored well on Step 3 CCS what separated them from the pack, and you will hear the same thing: preventive care and discharge planning. These are the points that most test-takers leave on the table because they are so focused on diagnosing and treating the acute problem that they forget to address the whole patient.

Preventive care may only account for approximately 5% of each case's score, but across 12–13 cases, those points add up. More importantly, they are almost free — you are not reasoning through a complex differential. You are running through a memorized checklist. This article gives you that checklist.

When to Add Preventive Care Orders

You have two opportunities to add preventive care in every CCS case:

During the case: If you are managing an outpatient case or the patient is stable on the floor, you can add preventive care orders at any point. For example, if you are seeing a 55-year-old woman for diabetes management in clinic, you can order a mammogram and colonoscopy referral alongside your HbA1c and lipid panel.

On the 2-minute screen: This is where most test-takers add preventive care. When the case ends and you get the final 2-minute window, run through your checklist and add everything that applies. You will not see results, but the scoring algorithm gives you credit.

The Universal Preventive Care Checklist

Use this checklist for every CCS case. Not every item applies to every patient — match it to the patient's age, sex, and risk factors.

Cancer Screening

Vaccinations

Screening Labs and Tests

Counseling

This is perhaps the easiest category to score points in. For any CCS case, consider which of these counseling orders apply:

The Discharge Order Bundle

When a CCS patient is being discharged (or when you are on the 2-minute screen for an inpatient case), think through this discharge checklist:

Medications

• Continue or adjust any medications started during the admission

• Prescribe new outpatient medications as appropriate

• Ensure pain management if needed (appropriate outpatient analgesics)

Follow-Up

• Schedule a follow-up appointment (1–2 weeks for most hospital discharges)

• Order follow-up labs for a specific future date (e.g., repeat BMP in 1 week for AKI, repeat LFTs in 3 months for new statin)

• Arrange specialist follow-up if consulted during admission

Education and Counseling

• Disease-specific education (diabetes self-management, CHF weight monitoring, asthma action plan)

• Medication counseling (how to take, side effects to watch for)

• Return precautions (when to come back to the ER)

Preventive Care

• Any age-appropriate screenings that were due

• Vaccinations that were due

• Health maintenance items identified during the admission

Preventive Care by Age and Sex: Quick Reference

Men Under 40

• Lipid panel (if not done recently)

• HIV screening (at least once)

• Hepatitis C screening (at least once)

• Depression screening

• STI screening if at risk

• HPV vaccine (if under 26 or catch-up to 45)

• Counseling: smoking, alcohol, diet, exercise, safe sex, seatbelt

Women Under 40

• All of the above, plus:

• Pap smear (starting at 21)

• Pregnancy test (if childbearing age and relevant)

• Contraception counseling

• Folic acid supplementation if planning pregnancy

• Breast exam discussion

• Chlamydia/gonorrhea screening if under 25 or at risk

Men 40–64

• All of the above, plus:

• Colonoscopy (starting at 45)

• Diabetes screening (if overweight, starting at 35)

• Lung cancer screening (if 20+ pack-year history, age 50+)

• Prostate cancer discussion (ages 55–69, shared decision)

Women 40–64

• All of the above, plus:

• Mammogram (starting at 40)

• Colonoscopy (starting at 45)

• Diabetes screening (if overweight, starting at 35)

• Lung cancer screening (if 20+ pack-year history, age 50+)

Adults 65+

• All age-appropriate screenings, plus:

• Pneumococcal vaccine (PCV13 + PPSV23)

• Shingles vaccine (Shingrix)

• AAA screening for men who ever smoked

• DEXA scan for women (and men with risk factors)

• Fall risk assessment

• Cognitive screening if indicated

• Advance directive discussion

The 2-Minute Screen Speed Run

When the 2-minute screen appears, run through this mental checklist as fast as possible:

1. Follow-up appointment — Did I schedule one? If not, do it now.

2. Follow-up labs — What needs to be rechecked? Order for future date.

3. Smoking? — Order smoking cessation counseling.

4. Age-appropriate cancer screening — Colonoscopy? Mammogram? Lung CT?

5. Vaccines — Flu shot? Pneumococcal? Shingrix?

6. Chronic disease screening — Lipid panel? HbA1c? Depression screen?

7. Counseling — Diet? Exercise? Medication adherence?

8. Missed treatment orders — Anything I wanted to order but ran out of time?

Practice this checklist until it becomes automatic. On exam day, you should be able to run through it in under 90 seconds, leaving 30 seconds as buffer.

Common Preventive Care Mistakes on CCS

Mistake 1: Skipping preventive care entirely. Even though it is only ~5% per case, it adds up. More importantly, it is zero-effort points.

Mistake 2: Ordering screening that is not age-appropriate. A colonoscopy on a 30-year-old with no risk factors is not indicated and wastes your time. Match screenings to current USPSTF guidelines.

Mistake 3: Ordering a statin before you have the lipid panel. If you prescribe a statin but have not ordered a lipid panel yet, and the report time has not been reached, the lipid panel is not scored as valid. Order the lipid panel, wait for results (or leave it active), then decide on treatment.

Mistake 4: Trying to discontinue all inpatient orders on the 2-minute screen. The 2-minute screen is not a discharge order screen. Do not waste time clicking through active orders to discontinue them. Use that time for preventive care and follow-up.

Mistake 5: Forgetting counseling. Counseling orders are the lowest-effort, highest-yield preventive action. If the patient smokes, order smoking cessation. If they are overweight, order diet and exercise counseling. These take seconds to enter.

Save this checklist to your phone or print it out for quick reference during your study sessions. This is the kind of systematic approach that turns CCS from overwhelming to routine.

Related Articles:

• Ultimate Guide to CCS Section of Step 3 (2026)

• 10 CCS Tips That Actually Work (2026)

• How CCS Scoring Actually Works (2026)

• 5 CCS Mistakes That Cost You Points

• Must-Know CCS Order Sets: The Free Database