Medicare health assessment for people with an intellectual disability Department of Health & Ageing Page




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Medicare health assessment for people with an intellectual disability Department of Health & Ageing Page


Health Check Item 718 or 719
Use of a specific form to record the results of the health assessment is not mandatory but the health assessment should cover the matters listed below. The first 2 pages/ 2 sides of this form can be used as a report of the health assessment. This check list must be read in conjunction with the explanatory notes for Items 718 and 719 (as set out in the Medicare Benefits Schedule Book).

Patient’s Name:

Male Female DOB: …..….../……...../…………….... or Age: ………………….………………………………

Current contact details


Address .

Phone


Carer’s name/s . Phone

Alternate carer’s name/s Phone

Carer's contact details


Consent – Patient and/or Carer

Explanation of health assessment given Yes

Patient consent for health assessment given Yes

Date consent was given: ……..../……..../…………..



Consent given for information to be collected by:

Nurse Yes No

Other health professional Yes No

- please specify ……………...……….………………………





Previous health check – Has the patient had a previous health assessment?  Yes  No

Date of last health assessment (if known) …..…../…..…../……..… Service provided by Dr..……………….………………..



PATIENT’S OVERALL HEALTH STATUS

HEALTH ISSUES IDENTIFIED AND DISCUSSED WITH PATIENT AND/OR CARER



TESTS UNDERTAKEN, RESULTS AND WHAT THEY MEAN (some results may not yet be available)

Note: The assessment should not include diagnostic or pathology services unless the health assessment detects issues that require clinically relevant diagnostic imaging or pathology services.



Test

Available results and what they mean


























RECOMMENDED INTERVENTION ACTION

ACTION TO BE TAKEN BY PATIENT AND/OR CARER
Next appointment with doctor: Date: ……….../…….…../………....

Next Health Assessment: Date: ………../……….../…………..

GP: Dr.

GP’s signature ……………………………………………………………………..……………. Date: …..…../……..../…..……....


PATIENT HISTORY


Paediatrician




Government-provided or funded disability service




Previous presentations




Family relationships




Care arrangements







Current problems

Current risk factors


























ALLERGIES / DRUG INTOLERANCE
HEALTH ASSESSMENT as relevant to the patient (mandatory from this point forward).

  • Check dental health (including dentition)

Identified health issues

Action






















  • Conduct aural examination (arrange formal audiometry every 5 years)

Identified health issues

Action






















  • Assess ocular health (arrange ophthalmologist / optometrist review every 5 years)

Identified health issues

Action






















  • Assess nutritional status and review growth and development weight ………..….…….. height ………..………..

Identified health issues

Action






















  • Assess bowel and bladder function (particularly for incontinence and chronic constipation)

Identified health issues

Action






















  • Assess medications (including non-prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications).

Identified health issues

Action


















Check immunisation status (refer to the current Australian Standard Vaccination Schedule [NHMRC] for appropriate vaccination schedules).

 Influenza  Measles  Tetanus  Mumps

 Hepatitis A  Hepatitis B  Rubella (MMR)  Pneumococcal



Identified health issues

Action






















  • Check exercise opportunities(aim for at least 30 minutes of moderate exercise per day)

Identified health issues

Action






















Identified health issues

Action






















  • Consider the need for breast examination, mammography, Papanicolaou smears, testicular examination, lipid measurement and prostate assessment

Identified health issues

Action





















  • Check for dysphagia and gastro-oesophageal disease, especially for patients with cerebral palsy, and arrange investigation/treatment as required.

Identified health issues

Action






















  • Assess risk factors for osteoporosis and arrange investigation/treatment as required.

Identified health issues

Action






















  • For patients diagnosed with epilepsy, review seizure control (including anticonvulsant drugs) and refer to neurologist as appropriate.

Identified health issues

Action






















  • Screen for thyroid disease at least every two years (or yearly for patients with Down syndrome)

Identified health issues

Action






















  • For patients without a definitive aetiological diagnosis, consider referral to a genetic clinic every 5 years.

Identified health issues

Action






















  • Assess or review treatment for comorbid mental health issues.

Identified health issues

Action






















  • Consider timing of puberty and management of sexual development, sexual activity and reproductive health.

Identified health issues

Action






















Identified health issues

Action




















HEALTH ASSESSMENT as relevant to the patient (Non-mandatory from this point forward).

The balance between the patient's health and physical, psychological and social function domains is a matter for professional judgement In relation to each patient. Practitioners should also consider the following:


Medical


  • Consider follow-up consultations where required, eg. high blood pressure, likelihood of other health problems

  • Assess pathology if continence problems are evident

Action








Physical function

  • Consider the health impact of the patient's general skills levels and daily activities

  • Consider the need for a referral for a formal review of activities of daily living.

Action








Psychological function

  • Consider & investigate medical/ psychiatric causes where problems with cognition & skill decline are clinically suspected

  • Consider depression where there is change in weight, sleep habit and escalation of behavioural problems

  • Ensure there are systems in place to keep track of the patient’s current behavioural status

  • Consider psychiatric disorders when changes in behaviour are evident.

Action








Social function

  • Assess suitability of the patient’s accommodation setting to provide best physical & psychological health outcomes

  • Consider issues that relate to the care provided by the patient’s carer to meet the health related needs of the patient

Action










  • Other examinations as considered necessary by GP

Examination

Identified health issues

Action




















Involving the patient's carer or appropriate disability professionals

  • Consider need for referrals such as accommodation, daily assistance, disability support services & psychologists.

Action










Proforma provided by North West Melbourne Division of General Practice, PO Box 3239, Broadmeadows Vic 3047 Tel: 03 8345 5600


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