Passport to better health - Primary Health Tasmania · the Passport to better health. This booklet...

Passport to better health

While the Australian Government helped fund this document, it has not reviewed the content and is not responsible for any injury, loss or damage however arising from the use of or reliance on the information provided herein.

www.primaryhealthtas.com.au© April 2016

Welcome to the Passport to better health.This booklet will help you keep track of your healthcare journey.

Having this information will help you to share in decision-making so you can get the care that fits with your goals and lifestyle.

It’s your passport to better health.

ABOUT ME PAGE 5

MY HEALTH PAGE 13

RESOURCES PAGE 33

NOTES PAGE 37

Questions about your care Being involved in decisions about your care is important. It’s ok to ask questions of your care providers. Consider these questions to make sure your care is shared with you:

S Safe Do you feel safe and supported?

H Heard Have you been heard and understood?

A Agreed Plan Does the plan reflect your goals and concerns?

R Relationships Have the important people in your life been included?

E Easy Information Have you received useful information that is easy to understand?

D Destination Do you know where you’re doing next and have the arrangements been made?

About me Use this section to keep your personal details in one place, and share important information about yourself with your care providers.

Personal details

Name __________________________________________

Address ________________________________________

________________________________________________

Telephone ______________________________________

Mobile _________________________________________

Date of Birth ____________________________________

Email __________________________________________

Medicare No. ___________________________________

Pension No. ____________________________________

Private Health fund ______________________________

Yes, I have a DVA Card

Yes, I have a Hearing Services number

Yes, I have an NDSS Card

Care informationUse this page to direct care providers to additional information about your care.

Yes, I have a Care Plan Location _________________________________

Yes, I have an Advance Care Directive Location _________________________________

Yes, I have an Enduring Guardian Location _________________________________

Yes, I have a person who can make decisions on my behalf

Name _________________________________________

Relationship ___________________________________

Telephone ______________ Mobile _______________

Other care information

_______________________________________________

Important peopleList the people who you want to be included as part of your care.

In case of emergency

Name __________________________________________

Relationship ____________________________________

Telephone ______________________________________

Mobile _________________________________________

Family or friends who provide care for you

Name __________________________________________

Relationship ____________________________________

Telephone ______________________________________

Mobile _________________________________________

Additional family and/or friends

Name _________________________________________

Relationship ___________________________________

Telephone _____________________________________

Mobile ________________________________________

Name _________________________________________

Relationship ___________________________________

Telephone _____________________________________

Mobile ________________________________________

Name _________________________________________

Relationship ___________________________________

Telephone _____________________________________

Mobile ________________________________________

Considerations for your health and wellbeing Use these pages to share your considerations for your health and wellbeing with care providers.

Health considerations

________________________________________________

Personal, home or family considerations

_______________________________________________

Considerations for your health and wellbeing

Cultural and/or religious considerations

________________________________________________

My health Use this section to keep track of your health information so you can share it with care providers.

Medical conditionsList the medical conditions you are experiencing. Ask your care providers to help you complete this.

Condition Year diagnosed

AllergiesList your allergies. Ask your care providers to help you complete this.

Allergy Reaction

MedicationsList the medication you’re taking, prescription or non-prescription. Ask your care providers to help you complete this.

Name of Medication Reason

Medications Name of Medication Reason

Medications

Doctor/Practice

Pharmacy

Hospital

Service

Contact

Care providersList the services and/or providers who are part of your care. E.g. doctor, support worker, psychologist.

Service

Contact

Care providers

Date and time ___________________________________

With whom/role _________________________________

Location ________________________________________

Notes __________________________________________

________________________________________________

Appointments or who you have seenList your upcoming appointments, or people you have seen that are part of your care. E.g. doctors, community nurses, home care.

EXAMPLE

29 June 2pm

Acme Medical Centre, HobartShort consultation regarding

medication

GPDr R Johnson

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

_________________________________STAMP OR

INITIAL

STAMP OR INITIALRJ

Appointments or who you have seen

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

Date and time _______________________________

With whom/role _____________________________

Location ____________________________________

Notes ______________________________________

_________________________________

STAMP OR INITIAL

Resources Consult this section when you need additional health-related information or support.

Important services and numbersHere are a few numbers if you feel you need additional support. List any other services that are relevant to you.

After Hours GP Helpline 1800 022 222Medical advice outside working hours

Emergency police/fire/ambulance 000Medical emergency response

Non-urgent ambulance 1800 008 008Non-emergency treatment and transport

Poisons information centre 12 11 26Information for poisoning or suspected poisoning

Lifeline 13 11 14Crisis support and suicide prevention

Beyond Blue 1300 224 636Mental health support

My Aged Care 1800 200 422Aged care services, eligibility, entitlements, being a carer

Important services and numbers Other

________________________________________________

Notes Use this section to write down any notes, reminders, questions, or comments to help you keep your care organised.

________________________________________________

GPO Box 1827 Hobart TAS 7001 Level 4, 15 Victoria Street, Hobart TAS 7000

Email sdra@primaryhealthtas.com.au Phone 03 6213 8200

Fax 03 6213 8260www.primaryhealthtas.com.au

Passport to better health - Primary Health Tasmania · the Passport to better health. This booklet...

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