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Health Check Forms | Adult Health Check Tools | Child Health Check Tools | Care Plan Summaries | Health Promotion Tools
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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. |
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Form ID Number |
Form ID Number |
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 1-6 weeks |
SW050 |
2 years |
SW056 |
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| 2 months |
SW051 |
3 years |
SW057 |
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| 4 months |
SW052 |
4 years |
SW058 |
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| 6 months |
SW053 |
5-14 years |
SW060 |
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| 9 months |
SW047 |
15-54 years |
SW061 |
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| 12 months |
SW054 |
45-49 years |
SW062 |
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| 15 months |
SW048 |
55+ years |
SW064 |
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| 18 months |
SW055 |
75+ years |
SW063 |
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| 21 months |
SW049 |
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| Care Management Plan / Review |
SW046 |
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| Referral Following Health Check |
SW211 |
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| Summary - Social Emotional Wellbeing Care for Adults |
(PDF, 145 KB) |
| Adult body mass index (BMI) chart |
(PDF, 58 KB) |
| Australian cardiovascular risk charts |
(PDF, 72 KB) |
| Standard Drink Guide |
(PDF, 361 KB) |
| High Sugar Drinks |
(PDF, 1.1 MB) |
| Asthma Action Plan (Asthma Foundation Queensland) External site |
(PDF, 2.7 MB) |
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| Summary - Social Emotional Wellbeing Care for Children for children aged 5 - 14 years |
(PDF, 107 KB) |
| Child (Girls) body mass index (BMI) chart |
(PDF, 82 KB) |
| Child (Boys) body mass index (BMI) chart |
(PDF, 98 KB) |
| Criteria for hearing screening referral for all children aged 6-11 years and 13-14 years |
(PDF, 235 KB) |
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(PDF, 235 KB) |
| High Sugar Drinks |
(PDF, 1.1 MB) |
| Standard Drink Guide |
(PDF, 361 KB) |
| Coronary Heart Disease |
(PDF, 177 KB) |
Pregnancy with Type I or II Diabetes |
(PDF, 143 KB) |
| Cardiac Rehabilitation |
(PDF, 97 KB) |
Syphilis |
(PDF, 121 KB) |
| Dyslipidaemia |
(PDF, 189 KB) |
Chlamydia, Gonorrhoea, PID |
(PDF, 133 KB) |
| Hypertension |
(PDF, 167 KB) |
Trichomoniasis |
(PDF, 117 KB) |
| Rheumatic Fever and Heart Disease |
(PDF, 154 KB) |
Chronic Hepatitis B |
(PDF, 96 KB) |
| Fetal Alcohol Spectrum Disorder |
(PDF, 171 KB) |
Depression |
(PDF, 139 KB) |
| Developmental delay in children |
(PDF, 166 KB) |
Anxiety |
(PDF, 138 KB) |
| Poor growth in children |
(PDF, 177 KB) |
Asthma (Adult) |
(PDF, 145 KB) |
| Gestational Diabetes Mellitus (GDM) |
(PDF, 132 KB) |
Chronic Obstructive Pulmonary Disease |
(PDF, 161 KB) |
| Postnatal Gestational Diabetes Mellitus |
(PDF, 111 KB) |
Overweight and obese adults |
(PDF, 192 KB) |
| Pre-diabetes |
(PDF, 153 KB) |
Overweight and obese children/adolescents |
(PDF, 141 KB) |
| Type 2 Diabetes |
(PDF, 159 KB) |
Chronic Kidney Disease |
(PDF, 118 KB) |
| High risk foot |
(PDF, 98 KB) |
High Stroke Risk / Post Stroke |
(PDF, 161 KB) |
| Health Promotion Plan and Evaluation Template |
(Word, 63 KB) |
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| Health Promotion Plan and Evaluation Example |
(PDF, 42 KB) |
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