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Chronic Disease Tools

 

Health Check Forms

The Health Check forms are available to be downloaded from the list below. Hard copies of these forms can be ordered through FAMMIS or your local stores department.

For more information on how to order hard copies of the Health Check Forms for Queensland Health facilities please click here (PDF, 182 KB) and for private facilities please click here (PDF, 200 KB)

No patient information is collected through this web page. Queensland Health staff are bound by the Health Services Act 1991 regarding confidentiality and the Queensland Information Privacy Act 2009 regarding privacy. Clinicians both internal and external to Queensland Health must adhere to privacy and confidentiality legislation.

   Examples of Health Check Forms                            Form ID Number     
     Material Number     
1-6 weeks    1-6 weeks
SW050 10219435
2 months    2 months SW051 10219436
4 months    4 months SW052 10219437
6 months    6 months SW053 10219438
9 months    9 months SW047 10219432
12 months    12 months SW054 10219439
15 months    15 months SW048 10219433
18 months    18 months SW055 10219440
21 months    21 months SW049 10219434
2 years    2 years SW056 10219441
3 years    3 years SW057 10219442
4 years    4 years SW058 10219443
5-14 years    5-14 years SW060 10219445
15-54 years    15-54 years SW061 10219446
45-49 years    45-49 years SW062

 10219447

55+ years    55+ years SW064

 10219449

75+ years    75+ years SW063 10219448
Care Management Plan / Review    Care Management Plan / Review SW046 10219431
Referral Following Health Check    Referral Following Health Check SW211 10243648

 

Adult Health Check Tools

Click here    Summary - Social Emotional Wellbeing Care for Adults

(PDF, 145 KB)


Adult Health Check Tools

Click here    Adult body mass index (BMI) chart - External site
Click here    Australian cardiovascular risk charts - External site

(PDF, 183 KB)

Click here    Standard Drink Guide

(PDF, 361 KB)

Click here    High Sugar Drinks - External site

 

Click here    Asthma Action Plan - External site

 

 

 

 

 

 

Child Health Check Tools


Child Health Check Tools

Click here    Summary - Social Emotional Wellbeing Care for Children
        for children aged 5 - 14 years

(PDF, 107 KB)

Click here    Child (Girls) body mass index (BMI) calculator - external site

 

Click here    Child (Boys) body mass index (BMI) calculator - external site

 

Click here    Criteria for hearing screening referral
        for all children aged 6-11 years and 13-14 years

(PDF, 235 KB)

Click here    Criteria for visual screening referral
        for all children aged 5, 7-11 and 13-14 years

(PDF, 235 KB)

Click here    High Sugar Drinks - external site

 

Click here    Standard Drink Guide - external site

 

 Care Plan Summaries

Click here    Coronary Heart Disease

(PDF, 177 KB)

Click here    Pregnancy with Type I or II Diabetes

(PDF, 143 KB)

Click here    Cardiac Rehabilitation

(PDF, 97 KB)

Click here    Syphilis

(PDF, 121 KB)

Click here    Dyslipidaemia

(PDF, 189 KB)

Click here    Chlamydia, Gonorrhoea, PID

(PDF, 133 KB)

Click here    Hypertension

(PDF, 167 KB)

Click here    Trichomoniasis

(PDF, 117 KB)

Click here    Rheumatic Fever and Heart Disease

(PDF, 154 KB)

Click here    Chronic Hepatitis B - Health Care Summary 

(PDF, 96 KB)

Click here    Fetal Alcohol Spectrum Disorder

(PDF, 171 KB)

Click here    Depression

(PDF, 139 KB)

Click here    Developmental delay in children

(PDF, 166 KB)

Click here    Anxiety

(PDF, 138 KB)

Click here    Poor growth in children

(PDF, 177 KB)

Click here    Asthma (Adult)

(PDF, 145 KB)

Click here    Gestational Diabetes Mellitus (GDM)

(PDF, 132 KB)

Click here    Chronic Obstructive Pulmonary Disease

(PDF, 161 KB)

Click here    Postnatal Gestational Diabetes Mellitus

(PDF, 111 KB)

Click here    Overweight and obese adults

(PDF, 192 KB)

Click here    Pre-diabetes

(PDF, 153 KB)

Click here    Overweight and obese children/adolescents

(PDF, 141 KB)

Click here    Type 2 Diabetes

(PDF, 159 KB)

Click here    Chronic Kidney Disease

(PDF, 118 KB)

Click here    High risk foot

(PDF, 98 KB)

Click here    High Stroke Risk / Post Stroke

(PDF, 161 KB)

Click here    Chronic Hepatitis B Care Plan (PDF, 77KB)

 

 

 

 

 

 

 

 

 

 

 Health Promotion Tools

Health Promotion Plan and Evaluation Template

(Word, 63 KB)

Health Promotion Plan and Evaluation Example

(PDF, 42 KB)

 

 


Last Updated: 03 October 2014
Last Reviewed: 03 October 2014