GPMP Childhood Disability Dec 06 by X1dh07

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									                                      <<Miscellaneous:Practice Letterhead>>

            GP MANAGEMENT PLAN (MBS ITEM No. 721) (Childhood Disability)

Patient’s Name: <<Patient Demographics:Full Name>>               Date of Birth: <<Patient Demographics:DOB>>

Contact Details:                                                 Medicare or Private Health Insurance Details:
<<Patient Demographics:Full Address>>                            <<Patient Demographics:Medicare Number>>
                                                                 <<Patient Demographics:Health Insurance>>

Details of Patient’s Usual GP:                                   Details of Patient’s Carer (if applicable):
<<Doctor:Name>>
<<Doctor:Full Address>>



Date of last Care Plan/GP Management Plan (if done): <<Date of last Care Plan/GPMP>>

Other notes or comments relevant to the patient’s management plan:




PAST MEDICAL HISTORY

<<Clinical Details:History List>>

FAMILY HISTORY

<<Clinical Details:Family History>>

MEDICATIONS

<<Clinical Details:Medication List>>

ALLERGIES




Original template compiled by Monash Division of General Practice, November 2006
Patient’s Name: <<Patient Demographics:Full Name>>

                               GP MANAGEMENT PLAN (Childhood Disability)
Patient problems /           Goals - changes to be achieved           Required treatments and             Arrangements for
needs / relevant                                                      services including patient          treatments/services
conditions                                                            actions                             (when, who, contact
                                                                                                          details)
1. General
Family and/ patients         Family and/patient to have a clear    Family and patient education           GP
understanding of             understanding of disability and their                                        Paediatrician
disability                   role in ongoing management                                                   Social worker
                                                                                                          Occupational Therapist
                                                                                                          Physiotherapist
                                                                                                          Speech therapist
2. Development
Language development Enabling the child to acquire the                Assist receptive language           GP to monitor
                     capacity to communicate their wants              development, the ability to receive Allied Health Services
                     or needs, feelings and thoughts with             and understand language. To be Speech Therapist
                     another                                          able to understand the thoughts,
                                                                      feelings, desires and the needs of
                                                                      others

Non verbal                   Enabling the child to recognize and Play therapy / Early Intervention        Allied health
communication                communicate through body                                                     professionals
                             language, gestures and facial
                             expressions
Social skills                The child learns the skills, rules and   Assist expressive language          GP
                             values that will enable them to form     development, the ability to speak   Family
                             connections and function among           and use language to                 Allied health
                             family members, peers and                communicate.                        professionals
                             members of society                       Family and patient education
Cognitive development To help develop the functions of the Play therapy / Early Intervention              GP
                      brain including perception, memory,                                                 Family
                      imagination and use of language                                                     Allied health
                                                                                                          professionals
Emotional skills             The child is able to understand,    Play therapy / Early Intervention        GP to monitor
                             express and regulate their emotions                                          Allied Health Services
Gross motor skills           To increase the abilities that           Patient exercise routine            Physiotherapist
                             requires coordination of large
                             muscles of the body such as
                             jumping or climbing
Fine motor skills            To increase the abilities that require Play therapy / Early Intervention     Play therapist
                             coordination of the small muscles of                                         Physiotherapist
                             the body                                                                     Occupational Therapist
Physical development         Achieve appropriate height, weight, Normal healthy diet                      GP
Growth                       muscle development and bone                                                  Family
                             thickness                                                                    Dietitian
                                                                                                          Maternal and child
                                                                                                          health nurse
Gait                         The ability to move symmetrically,       Exercise routine                    Physiotherapist
                             where both legs move at the same
                             time
3. Daily Living Skills
Ability to carry out         Enabling the child to carry out the      Assisting the child to grow and     GP
activities of daily living   necessary tasks and functions            develop and to obtain additional    Family/child
                             required to function on a daily or       skills to become as independent     Allied Health
                             regular basis                            as possible                         professionals
4. Biomedical
Investigations               Early detection and treatment of any Pathology as required                   GP
                             problems                             Radiology as required
5. Medication
Medication review            Correct use of medications,              Family and/ patient education       GP to review and
                             minimise side effects                    Review medications                  provide education



Original template compiled by Monash Division of General Practice, November 2006
6. Preventative care
Childhood                  Preventative care                       Ensure up to date with all            GP
immunisations                                                      childhood immunisations               Family
Eye care                   Early detection and treatment of any Initial eye check and ongoing            GP
                           problems                             review and treatment as required         Eye specialist
                                                                Referral by GP
Foot care                  Prevent foot complications              Patient education on foot care        GP / podiatrist
                                                                   Patient/ family to check feet         Patient/family
                                                                   regularly                             GP
                                                                   Check feet every 6 months
7. Family support
Family’s need for          Honest communication between            Honest communication between          GP
assistance support         patient, family, GP and health care     patient, family, GP and health care   Patient
                           professionals.                          professionals.                        Family
                                                                   Case management                       Health care
                                                                   Carer respite                         professionals
                                                                   Disabled parking                      Local Council
                                                                   Carer allowance / pension             home help

Copy of GP Management Plan offered to patient? <<Copy of GPMP offered to patient?>>

Copy / relevant parts of the GP Management Plan supplied to other providers? <<Copy of GPMP supplied to
other providers?>>

GP Management Plan added to the patient’s records? <<GPMP added to patient's records?>>

Date service was completed: <<Date service                       Proposed Review Date: <<Proposed review date
completed>>                                                      (recommended 6 months)>>


I have explained the steps and any costs involved, and the patient has agreed to proceed with the plan. <<Steps
and costs explained, patient agreed>>

 GP’s Signature: ________________________________________________ Date:___________________




Original template compiled by Monash Division of General Practice, November 2006

								
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