Medicare Health Assessment For Aboriginal And Torres Strait Islander People (Mbs Item 715) printable pdf download

Medicare Health Assessment For Aboriginal And Torres Strait Islander People (Mbs Item 715)

Medicare Health Assessment for

Aboriginal and Torres Strait Islander People (MBS Item 715)

Child Health Assessment (0-14)

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 in the Explanatory Notes at

Patient’s Name …………………………………………..

Male

Female

DOB: __/__/____ or Age:__

Aboriginal

Torres Strait Islander

Aboriginal and Torres Strait Islander

Current contact details

Parent or Carer’s name/s …………………………..….

Alternative contact details ……………………………..

Address ………………………………………………….

Phone ……………………………………………………

Consent – Patient or Parent/Carer

Consent given for information to be collected by:

Explanation of health check given

Yes

Aboriginal and Torres Strait Islander

Patient consent for health check given Yes

health practitioner

Date consent was given:

__/__/____

Practice nurse

Other suitably qualified health professional

Previous health assessment

Has the patient had a previous health assessment?

Date of last health assessment (if known) __/__/____

Yes

Service provided by Dr. .………………………………..

PATIENT’S OVERALL HEALTH

………………………………………………………………………………………………………………………………

RISK FACTORS IDENTIFIED AND DISCUSSED WITH PATIENT OR PARENT/CARER

………………………………………………………………………………………………………………………………

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

TEST

AVAILABLE RESULTS AND WHAT THEY MEAN

Medicare Health Assessment For Aboriginal And Torres Strait Islander People (Mbs Item 715)