Annual Health Check Form

  • Steps to follow:

    • House Leader or Key Worker to complete section 1, involving person and family member where possible.
    • Steps to be advised around process
    • Make a 30 minute appointment with the Practice Nurse and 30 minutes with the GP. Practice Nurse will be able to assist with completing some of the questions prior to GP assessment.
    • Take this assessment along to the appointment for the GP to complete.
    • Ensure the GP also completes the Action Plan at the end.

    Additional items to the to the appointment

    • Medication chart
    • Weight chart
    • Other relevant records: Seizure chart; Bowel chart; Blood sugar level chart.
    • The Person’s Family history and Personal history. (?Health support plan part 2)

    Internal Health Screen Requirement

    Dysphagia

  • (This can include behaviours such as watery eyes, turning head away, pushing food away, clamping mouth shut and refusal to eat)
  • If you have answered YES to any of these questions then refer the person to the Spectrum Communication Team

    Health

  • (cancer, heart disease, diabetes, COPD, dementia) NB this does NOT include Epilepsy
  • If you have answered YES to any of these questions then refer the person to the Spectrum Health Team

    Falls

  • If you have answered YES to any of these questions then complete a Falls Risk Calulator and refer the person to the Spectrum Health Team

    Annual Health Check

    To be completed by House Leader or Key worker, involving Person/family member where possible