Smart Forms
0.2.0 - ci-build
Smart Forms, published by AEHRC CSIRO. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/aehrc/smart-forms-ig/ and changes regularly. See the Directory of published versions
Official URL: http://www.health.gov.au/assessments/mbs/715 | Version: 0.2.0-assembled | |||
Draft as of 2024-04-02 | Computable Name: AboriginalTorresStraitIslanderHealthCheck | |||
Copyright/Legal: Copyright © 2022+ Australian Government Department of Health and Aged Care - All rights reserved. This content is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. See https://creativecommons.org/licenses/by-sa/4.0/. |
Aboriginal and Torres Strait Islander Health Check assessment form.
The long-term vision for effective Aboriginal and Torres Strait Islander health checks is of a standards-based health check template that is consistent and interoperable across different systems and applications whilst allowing for local adaptation.
The NACCHO and RACGP established a working group to review the Aboriginal and Torres Strait Islander annual health check templates and have produced five new templates that span the life course:
These example templates can be downloaded from the RACGP.
This resource is FHIR Questionnaire representation of the templates above.
Generated Narrative: Questionnaire AboriginalTorresStraitIslanderHealthCheck
StructureLinkID | Text | Cardinality | Type | Flags | Description & Constraints |
---|---|---|---|---|---|
![]() ![]() | Aboriginal and Torres Strait Islander Health Check assessment form. | Questionnaire | http://www.health.gov.au/assessments/mbs/715#0.2.0-assembled | ||
![]() ![]() ![]() | null | 0..1 | group | ||
![]() ![]() ![]() ![]() | About the health check | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-1 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-1 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Eligible for health check | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | not claimed 715 or 228 in past nine months | 0..1 | display | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Health check already in progress? | 0..1 | boolean | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Date of last completed health check | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Date this health check commenced | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Consent | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-30 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-30 = | |
![]() ![]() ![]() ![]() ![]() | Consent given after discussion of process and benefits of a health check | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() | Consent given by parent/primary carer after discussion of process and benefits of a health check | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() | Parent/primary caregiver present | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Parent/primary caregiver is present for health check? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Relationship to child | 0..* | string | Enable When: c72933c7-349f-4fef-94ff-c424c69da6f3 = | |
![]() ![]() ![]() ![]() ![]() | Consent for sharing of information | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Consent given for sharing of information with relevant healthcare providers? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Who/details | 0..* | text | Enable When: 057483ce-f265-46df-a1c5-7a18d492c1ba = | |
![]() ![]() ![]() ![]() ![]() | Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Doctor | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Nurse | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Aboriginal and/or Torres Strait Islander Health Worker / Health Practitioner | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Location of health check | 0..1 | open-choice | Options: 3 options | |
![]() ![]() ![]() ![]() ![]() | Location of health check | 0..1 | open-choice | Options: 3 options | |
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Patient Details | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-32 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-32 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Name | 0..1 | string | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Preferred name | 0..1 | string | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Preferred pronouns | 0..1 | choice | ![]() ![]() | Value Set: Australian Pronouns |
![]() ![]() ![]() ![]() ![]() | Gender identity | 0..1 | choice | ![]() ![]() | Value Set: Gender Identity Response |
![]() ![]() ![]() ![]() ![]() | Administrative gender | 0..1 | choice | ![]() ![]() | Value Set: AdministrativeGender |
![]() ![]() ![]() ![]() ![]() | Sex assigned at birth | 0..1 | choice | ![]() ![]() | Value Set: Biological Sex |
![]() ![]() ![]() ![]() ![]() | Date of birth | 0..1 | date | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Age | 0..1 | integer | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Aboriginal and/or Torres Strait Islander status | 0..1 | choice | ![]() ![]() | Value Set: Aboriginal and/or Torres Strait Islander |
![]() ![]() ![]() ![]() ![]() | Parents/primary carer/s | 0..* | choice | Value Set: Primary Carer Of Parent Or Grandparent | |
![]() ![]() ![]() ![]() ![]() | Other family | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Other | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Parents/primary carer/s details | 0..* | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Name of parent/primary carer | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Relationship to child | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Home address | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | No fixed address | 0..1 | boolean | Definition: Address.extension:noFixedAddress | |
![]() ![]() ![]() ![]() ![]() ![]() | null | 0..* | group | Enable When: 311d83bb-f22e-4f60-9b50-b6e38dd2059b != | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Street address | 0..1 | string | Definition: Address.line | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | City | 0..1 | string | Definition: Address.city | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | State | 0..1 | choice | Definition: Address.state Value Set: Australian States and Territories | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Postcode | 0..1 | string | Definition: Address.postalCode | |
![]() ![]() ![]() ![]() ![]() | Postal address | 0..* | group | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() ![]() | Purpose of use | 0..1 | string | Definition: Address.use | |
![]() ![]() ![]() ![]() ![]() ![]() | Address | 0..1 | string | Definition: Address.line | |
![]() ![]() ![]() ![]() ![]() ![]() | City | 0..1 | string | Definition: Address.city | |
![]() ![]() ![]() ![]() ![]() ![]() | State | 0..1 | choice | Definition: Address.state Value Set: Australian States and Territories | |
![]() ![]() ![]() ![]() ![]() ![]() | Postcode | 0..1 | string | Definition: Address.postalCode | |
![]() ![]() ![]() ![]() ![]() | Home phone | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() | Mobile phone | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() | Emergency contact | 0..* | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Name | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Relationship to child | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Relationship to patient | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Phone | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() | Medicare number | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Number | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Reference number | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Expiry | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Pensioner Card Number | 0..1 | string | Max Length: 10 | |
![]() ![]() ![]() ![]() ![]() | Health Care Card Number | 0..1 | string | Max Length: 10 | |
![]() ![]() ![]() ![]() ![]() | Registered for Closing the Gap PBS Co-payment Measure (CTG) | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() | Child has a birth certificate | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() | My Aged Care | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Registered for My Aged Care | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | My Aged Care Number | 0..1 | string | Enable When: 7165c072-e3d8-4564-9d1d-d17f6807787c = | |
![]() ![]() ![]() ![]() ![]() | National Disability Insurance Scheme | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Registered for NDIS | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | NDIS Number | 0..1 | string | Enable When: 924b4500-53ac-4c4e-831b-7ab5569ff981 = | |
![]() ![]() ![]() ![]() ![]() | Children | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have children? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Number of children | 0..1 | integer | Enable When: e90b436b-2751-4e07-a40c-adfe951b6528 = | |
![]() ![]() ![]() ![]() ![]() ![]() | Number of children in your care | 0..1 | integer | Enable When: e90b436b-2751-4e07-a40c-adfe951b6528 = | |
![]() ![]() ![]() ![]() ![]() | Someone's carer | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are you responsible for caring for someone else? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: a08271f1-194b-4fe9-91f9-4f3398858eb0 = | |
![]() ![]() ![]() ![]() ![]() | Your carer | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have a carer? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: d05558fb-a3cc-4bd6-b803-b672b36b9c51 = | |
![]() ![]() ![]() ![]() ![]() | Providers | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are name and contact details of other key providers (eg case workers, support services) up to date? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Advance care planning | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Enduring Power of Attorney | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Enduring Power of Attorney | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Discussed today | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Advance Health Directive | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Advance Health Directive | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Discussed today | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Current health/patient priorities | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-5 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-5 = | |
![]() ![]() ![]() ![]() ![]() | What are the important things for you in this health check today? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything you are worried about? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's health or wellbeing? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Child Health Book | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Does your child have a Child Health Book? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Is it up to date? | 0..1 | choice | ![]() ![]() | Enable When: 2655e0e1-fe4b-431e-87af-30d4ff1aca76 = Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Do you have any specific health goals? Is there anything in particular about your health and wellbeing that you would like to improve? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Medical history and current problems | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-17 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-17 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Gestation at birth | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() ![]() | weeks | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Birth weight | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() ![]() | kg | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Medical history and current problems list | 0..* | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Condition | 0..1 | open-choice | Value Set: Clinical Condition | |
![]() ![]() ![]() ![]() ![]() ![]() | Clinical Status | 0..1 | choice | Value Set: Condition Clinical Status Codes | |
![]() ![]() ![]() ![]() ![]() ![]() | Onset Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Recorded Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | New diagnoses list | 0..* | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Condition | 0..1 | open-choice | Value Set: Clinical Condition | |
![]() ![]() ![]() ![]() ![]() ![]() | Clinical Status | 0..1 | choice | Value Set: Condition Clinical Status Codes | |
![]() ![]() ![]() ![]() ![]() ![]() | Onset Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Recorded Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Regular medications: check if still required, appropriate dose, understanding of medication and adherence | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-23 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-23 = | |
![]() ![]() ![]() ![]() ![]() | Does your child take any regular medications (prescribed, over-the-counter, traditional, complementary and alternative)? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Do you take any regular medications (prescribed, over-the-counter, traditional, complementary and alternative)? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Up to date in the health record? | 0..1 | boolean | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Medication understanding and adherence has been checked with patient | 0..1 | boolean | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Allergies/adverse reactions | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-3 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-3 = | |
![]() ![]() ![]() ![]() ![]() | Up to date in the health record? | 0..1 | boolean | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Family history | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-9 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-9 = | |
![]() ![]() ![]() ![]() ![]() | Provide relevant family history information | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Provide relevant family history information (including diabetes, heart disease, cancer, mental health) | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Social and emotional wellbeing | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-27 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-27 = | |
![]() ![]() ![]() ![]() ![]() | Stressful life events | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Have there been any particular stressful life events that are impacting on you/your health lately? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: e7297156-cfed-4437-b877-c345f744168b = | |
![]() ![]() ![]() ![]() ![]() | Social and emotional wellbeing assessment: consider tools such as Aboriginal and Torres Strait Islander Youth Social Emotional Wellbeing assessment question guide or HEEADSSS | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Consider conversation about social connection, which could include questions about sports/hobbies/clubs/other activities | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Social history: Information about family and child's living arrangements | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-28 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-28 = | |
![]() ![]() ![]() ![]() ![]() | Who lives in your household? / Who does the child live with? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Stressful life events | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Have there been any stressful life events that would cause you or your child to be upset? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 062f5234-686a-4bf3-afcd-3fcd988afd6c = | |
![]() ![]() ![]() ![]() ![]() | If indicated, ask about depression and other mental health concerns | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Home and family | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-12 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-12 = | |
![]() ![]() ![]() ![]() ![]() | Who do you live with? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Housing stability | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have stable housing? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: a7542da8-aad6-4a80-8b5b-806ca11d68d2 = | |
![]() ![]() ![]() ![]() ![]() | Home safety | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you feel safe at home? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 6f73d1ee-dd8e-419a-9142-ede367200e3b = | |
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Learning and development | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-15 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-15 = | |
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's development? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's learning? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's behaviour? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's sleep? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | What childcare/early learning centre/kindergarten does your child go to? How often? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | How often does your child miss childcare/early learning centre/kindergarten? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything you are worried about at school? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | How often does your child miss school? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is your child having any difficulties making friends? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Are there any other concerns about your child's learning and development | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Learning and work | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-33 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-33 = | |
![]() ![]() ![]() ![]() ![]() | Learning | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are you studying at school/uni? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Learning | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are you studying? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Work | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are you working? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details (occupation including occupational hazards, study, training, disability, etc) | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Work | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-16 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-16 = | |
![]() ![]() ![]() ![]() ![]() | Work | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are you working? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details (occupation including occupational hazards, study, training, disability, etc) | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Mood | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-19 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-19 = | |
![]() ![]() ![]() ![]() ![]() | How have you been feeling lately? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | If indicated, ask about depression (consider screening tools, eg aPHQ-9, K5 or K10) and complete risk assessment | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Explore other mental health concerns as indicated | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Memory and thinking | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-18 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-18 = | |
![]() ![]() ![]() ![]() ![]() | Personal concerns about your memory or thinking | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have any worries about your memory or thinking? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: e29701be-2b79-471d-a42e-7e3830459080 = | |
![]() ![]() ![]() ![]() ![]() | Family concerns about your memory or thinking | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Does anyone in your family have any worries about your memory or thinking? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 06a67326-9e3d-4c4c-b271-af5b168d077c = | |
![]() ![]() ![]() ![]() ![]() | If any concerns are raised and/or high risk for cognitive impairment identified, follow up with cognitive screening (eg clock test, GPCOG, KICA-Cog, MMSE) | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Chronic disease associated with ageing | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-4 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-4 = | |
![]() ![]() ![]() ![]() ![]() | For older people with chronic disease and/or conditions associated with ageing, consider assessing: Osteoporosis risk; Falls risk; Balance, coordination and mobility; Pain; Nutrition; Regularity of chronic disease management and review | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Participation in screening programs | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-24 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-24 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Cervical screening (age <=74 years) | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Cervical screening status | 0..1 | choice | Options: 5 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Cervical screening next due | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Cervical screening details | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Breast screening (age <=74 years) | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Breast screening status | 0..1 | choice | Options: 5 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Breast screening next due | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Breast screening details | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Bowel cancer screening (age <=74 years) | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Bowel cancer screening status | 0..1 | choice | Options: 5 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Bowel cancer screening next due | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Bowel cancer screening details | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Healthy eating | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-11 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-11 = | |
![]() ![]() ![]() ![]() ![]() | Child eating concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's feeding/eating? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's eating? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Breastfeeding history | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Bottle feeding history | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Diet or weight concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have any worries about your diet or weight? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 646302e9-d384-4943-99bc-11e638641703 = | |
![]() ![]() ![]() ![]() ![]() | Unintended weight loss | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Have you lost weight without trying to in the last three months? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 6dc96b26-cbc5-4434-8f6b-0260196311c2 = | |
![]() ![]() ![]() ![]() ![]() | Document conversation about age-appropriate healthy eating, which could include: current diet; transition to solids; dietary recommendations re fruit and vegetable intake, iron-rich foods, avoiding sugary drinks | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Document conversation about health eating which could include: current diet including food and drinks; recommendations about fruit and vegetable intake, water as the main drink, avoiding sugary drinks, avoiding highly processed foods (including supermarket-bought and take-away like KFC, Maccas, etc) | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Food availability issues | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are there any issues about availability of food? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 12a41538-5dbd-4c1d-af69-52c59c48b1a9 = | |
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Physical activity and screen time | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-34 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-34 = | |
![]() ![]() ![]() ![]() ![]() | Physical activity concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's level of physical activity? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 304d0332-9bfd-42dc-a4be-a5122596fb89 = | |
![]() ![]() ![]() ![]() ![]() | Screen time concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's level of screen time? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 465eacce-f9ee-4022-9186-89065cf01ce2 = | |
![]() ![]() ![]() ![]() ![]() | Physical activity or screen time concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have any worries about physical activity or screen time? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 08320c7a-831b-4237-95e2-d79aee155b90 = | |
![]() ![]() ![]() ![]() ![]() | Document conversation about age-appropriate recommendations re physical activity and screen time | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Document conversation about social connection, which could include questions about sports/hobbies/clubs/other activities | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Physical activity | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-21 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-21 = | |
![]() ![]() ![]() ![]() ![]() | Physical activity concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have any worries about physical activity? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: b30d5d21-c6d6-4bb3-aab4-0fdee80b3093 = | |
![]() ![]() ![]() ![]() ![]() | Document conversation about recommendations re physical activity | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Red flags early identification guide for children | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-22 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-22 = | |
![]() ![]() ![]() ![]() ![]() | This is based on material from the The State of Queensland, Red flags early identification guide (for children aged birth to five years). 2nd edn. South Brisbane, Qld: Child Development Program, Queensland Health, 2016. Available at www.childrens.health.qld.gov.au/wp-content/uploads/PDF/red-flags-a3.pdf [Accessed 2 December 2019]. © Developed by the Child Development Program in conjunction with Brisbane North Primary Health Network. Updated: July 2016. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | What age group is the child closet to? | 0..1 | choice | Options: 8 options | |
![]() ![]() ![]() ![]() ![]() | Red flags | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Social Emotional | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 1 option | |
![]() ![]() ![]() ![]() ![]() ![]() | Social Emotional | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 1 option | |
![]() ![]() ![]() ![]() ![]() ![]() | Social Emotional | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Social Emotional | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 1 option | |
![]() ![]() ![]() ![]() ![]() ![]() | Social Emotional | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 1 option | |
![]() ![]() ![]() ![]() ![]() ![]() | Social Emotional | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Social Emotional | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 1 option | |
![]() ![]() ![]() ![]() ![]() ![]() | Social Emotional | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 1 option | |
![]() ![]() ![]() ![]() ![]() ![]() | Communication | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 1 option | |
![]() ![]() ![]() ![]() ![]() ![]() | Communication | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Communication | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Communication | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Communication | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Communication | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Communication | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Communication | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Cognition, fine motor and self care | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 4 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Cognition, fine motor and self care | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 3 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Cognition, fine motor and self care | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Cognition, fine motor and self care | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Cognition, fine motor and self care | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 1 option | |
![]() ![]() ![]() ![]() ![]() ![]() | Cognition, fine motor and self care | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Cognition, fine motor and self care | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Cognition, fine motor and self care | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 3 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Gross motor | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Gross motor | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 4 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Gross motor | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Gross motor | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Gross motor | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Gross motor | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Gross motor | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Gross motor | 0..* | choice | Enable When: 0b520b20-98df-4024-b25d-2986f6b96e77 = Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Red flags at any age | 0..* | choice | Options: 7 options | |
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Substance use, including tobacco | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-29 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-29 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Smoking | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Smoking status | 0..1 | choice | Value Set: Tobacco Use Status | |
![]() ![]() ![]() ![]() ![]() ![]() | Quit status | 0..1 | choice | Enable When: b639a3a8-f476-4cc8-b5c7-f5d2abb23511 = Value Set: Smoking Quit Status | |
![]() ![]() ![]() ![]() ![]() ![]() | How many? | 0..1 | string | Enable When: | |
![]() ![]() ![]() ![]() ![]() ![]() | How long as a smoker? | 0..1 | string | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Alcohol and other substance use | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity and frequency of: alcohol; caffeine (coffee, soft drinks, iced coffee); cannabis/yarndi/gunja; other substance use: IVDU, methamphetamine, opiates, solvents, other | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Gambling | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-10 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-10 = | |
![]() ![]() ![]() ![]() ![]() | Gambling issues | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Have you or someone close to you ever had issues with gambling? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: a233c01e-a72e-474b-9a26-bab1504491fa = | |
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Sexual health (sexual activity, contraception, safe sex/protection, sexual orientation, gender identity, pressure to have sex, STIs) | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-36 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-36 = | |
![]() ![]() ![]() ![]() ![]() | Puberty and sexual health concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about in relation to puberty/your sexual health? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/Not Asked/Asked But Declined |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 1d20138a-caf3-4c43-9693-04c08d37a84a = | |
![]() ![]() ![]() ![]() ![]() | Consider discussing as relevant to age/sex/gender: menstruation (including risk of anaemia); current sexual activity; contraception; safe sex practice (eg use of condoms); sexually transmitted infection symptoms and screening; blood-borne virus screening | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Genitourinary and sexual health | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-35 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-35 = | |
![]() ![]() ![]() ![]() ![]() | Sexual health concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about in relation to your sexual health? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/Not Asked/Asked But Declined |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: e56e79e5-8fbb-43f0-b2a3-018b55750bd0 = | |
![]() ![]() ![]() ![]() ![]() | Cervical screening | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Cervical screening status | 0..1 | choice | Value Set: Cervical Screening Status | |
![]() ![]() ![]() ![]() ![]() ![]() | Next due | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Consider discussing as relevant to age/sex/gender: contraception; menstruation; sexually transmitted infection symptoms and screening; blood-borne virus screening; continence; menopause; erectile dysfunction | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Genitourinary and sexual health | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-25 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-25 = | |
![]() ![]() ![]() ![]() ![]() | Sexual health concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Consider asking when appropriate: Is there anything that you are worried about in relation to your sexual health? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/Not Asked/Asked But Declined |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 1c40a720-bdb7-4386-a9f6-be82b7349bf7 = | |
![]() ![]() ![]() ![]() ![]() | Continence issues | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have problems with urine leaking? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 64fd0f79-7e09-4934-905d-9bff6715f9ba = | |
![]() ![]() ![]() ![]() ![]() | Consider discussing as relevant to age/sex/gender: menopause; erectile dysfunction; prostatic symptoms | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Eye health | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-8 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-8 = | |
![]() ![]() ![]() ![]() ![]() | Vision concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's vision? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your vision? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Eye examination | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Red reflex (up to six months) | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Left eye | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Right eye | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Evidence of squint or other abnormality | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Left eye | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Right eye | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Visual acuity | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Left eye | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Right eye | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Trachoma Check (endemic areas) | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Left eye | 0..1 | choice | Options: 2 options | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Right eye | 0..1 | choice | Options: 2 options | |
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Ear health and hearing | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-6 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-6 = | |
![]() ![]() ![]() ![]() ![]() | Child listening concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's listening? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: f982c374-f023-4e68-8968-1f1f5d3969ae = | |
![]() ![]() ![]() ![]() ![]() | Child language concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything you are worried about with your child's language/talking? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 06c150f8-4d54-4d10-aeff-2ef7567b6812 = | |
![]() ![]() ![]() ![]() ![]() | Child snoring | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you notice snoring/noisy breathing at night/while your child is sleeping? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: b326271b-e9b1-45a0-b899-125364833702 = | |
![]() ![]() ![]() ![]() ![]() | Hearing concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your hearing? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 3e53edc7-c90e-4681-a006-b7a05b91a02c = | |
![]() ![]() ![]() ![]() ![]() | Last hearing test (audiology) | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Ear examination | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Otoscopy | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Video otoscopy procedure recommended where possible as it allows for parental education and for images to be saved for tracking over time | 0..1 | display | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Otoscopy findings | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Left ear | 0..* | open-choice | Options: 10 options | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Right ear | 0..* | open-choice | Options: 10 options | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Otoscopy findings | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Left ear | 0..* | open-choice | Options: 6 options | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | Right ear | 0..* | open-choice | Options: 6 options | |
![]() ![]() ![]() ![]() ![]() ![]() | Tympanometry | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Left ear | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Right ear | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Oral and dental health | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-20 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-20 = | |
![]() ![]() ![]() ![]() ![]() | Dental concerns | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's teeth or mouth? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your teeth? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Last dental checkup | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Dentures? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Teeth and mouth check | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Examination findings | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Document conversation about oral health and care of teeth | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Skin | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-26 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-26 = | |
![]() ![]() ![]() ![]() ![]() | Skin problems | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Does your child have any skin problems? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your skin? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Do you use sun protection? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Document conversation about sun protection as appropriate (ie sunscreen, hats, shade). | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | General skin examination findings | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Immunisation | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-13 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-13 = | |
![]() ![]() ![]() ![]() ![]() | Check Child Health Record/Book and Australian Immunisation Register | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Eligibility for funded vaccines may vary across jurisdictions | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Check Australian Immunisation Register | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Check recommended primary vaccinations completed and provide catch-up if required | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Immunisations up to date and recorded on Australian Immunisation Register (as per Australian immunisation handbook)? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Immunisations due | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() | Vaccines given today | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Vaccines recorded on Australian Immunisation Register? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 9f5787e6-8ece-46a4-8d67-e7c3e14daf18 = | |
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Examination | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-7 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-7 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Growth measures recorded on Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) growth charts for centile and tracking overtime | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | null | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Length/Height | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Value | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | cm | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Date performed | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Height | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Value | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | cm | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Date performed | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Weight | 0..1 | group | ||