For some older primary school children with higher risk behaviours, psychosocial factors and/or developmental indications, it may be appropriate to include some elements from the ‘Adolescents and young people’ health check template 
A good health check:
•	is useful to the patient and family
•	identifies health needs including patient health goals and priorities
•	supports families to take charge of their health and wellbeing
•	provides a framework for primary and secondary disease prevention through healthcare advice, risk assessment and other measures
•	is provided by the regular healthcare provider
•	includes a plan for follow-up of identified health needs, priorities and goals.
Disclaimer: This is an example health check template that includes recommended core elements and is intended for use as a general guide only. Health checks should always be completed based on clinical judgement of what is relevant to individual patients and settings. Adaptation to local needs and priorities is encouraged, with reference to current Australian preventive health guidelines that are culturally and clinically suitable to Aboriginal and Torres Strait Islander needs, evidence-based and generally accepted in primary care practice, for example:
•	National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people, 3rd edition, The Royal Australian College of General Practitioners (RACGP) and National Aboriginal Community Controlled Health Organisation (NACCHO)
•	CARPA standard treatment manual, 7th edition, Central Australian Rural Practitioner’s Association (CARPA). 
Where an individual practitioner or service has skills and capacity to provide culturally safe healthcare, the range of elements in the health check, and use of clinical screening and assessment tools, may be extended.
Key: 
•	Relevant to nKPIs
•	Relevant to QI PIP 
About the health check 	Yes	No	N/A		
Eligible for health check (not claimed 715 or 228 in past nine months):				Date of last health check: 	
Consent	
Consent given by parent/primary carer after discussion of process and benefits of a health check: 					
Parent/primary caregiver present for health check				Relationship to child:	
Consent given for sharing of information with relevant healthcare providers:				Who/details:	
Date:	Doctor:	Nurse:	
Aboriginal and/or Torres Strait Islander Health Worker / Health Practitioner:	
Location of health check:	

 Clinic	

 Home	

 School	

 Other: 	
Patient details	
Name: 	Date of birth: 	Age: 	Gender: 	
Aboriginal and/or Torres Strait Islander status:	

 Aboriginal	

 Torres Strait Islander	

 Aboriginal and Torres Strait Islander	
Parents/primary carer/s:	

 Mother	

 Father	

 Mother and father	

 Grandparent/s	
Other family (details):	Other (details):	
Names of parents/primary carer/s:	Relationship to child:	
Address:	
Home phone: 	Mobile phone:	
Emergency contact:	Relationship to child:	Emergency contact phone:	
Medicare number:	Reference number:	Expiry: 	
Pension/Health Care Card number:	
	Yes	No	N/A		
Registered for Closing the Gap 
PBS Co-payment Measure (CTG):					
Registered for National Disability 
Insurance Scheme				Yes, number:	
Are name and contact details of other key providers (eg case workers, support services) up to date?				Details:	

Assessment	Health priorities, actions and follow-up	
Current health/patient priorities
What are the important things for you in this health check today? 
Details: 
Is there anything that you are worried about with your child’s health 
or wellbeing?
Details:		
Medical history and current problems

 Recurrent cough or chest infections

 Recurrent ear infections/CSOM (glue ear/grommets)

 Growth or development problems

 Acute rheumatic fever/rheumatic heart disease 
(in high prevalence setting)

 Environmental exposure to tobacco smoke (eg at home, in car)

 Hospital admissions

 Other/relevant medical history
Details:		
Regular medications: check if still required, appropriate dose, understanding of medication and adherence

Does your child take any regular medications (prescribed, over-the-counter, traditional, complementary and alternative)?

 None  Yes, up to date in health record
 Understanding and adherence checked		

Allergies/adverse reactions 
 Up to date in health record		
Relevant family history
Details:		

Assessment	Health priorities, actions and follow-up	
Social history: Information about family and child’s 
living arrangements 
Who lives in your household?/Who does the child live with?
Details: 
Have there been any stressful life events that would cause you or your child to be upset?

Yes  No     Details:
If indicated, ask about depression and other mental health concerns
Details:  		
Learning and development
Questions that support a conversation about learning and development:
•	Is there anything that you are worried about with your child’s behaviour?
•	Is there anything that you are worried about with your child’s sleep?
•	Is there anything that you are worried about with your child’s learning?
•	Is there anything you are worried about at school? 
•	How often does your child miss school?
•	Is your child having any difficulties making friends?
Document conversation about learning and development
Details: 		
Healthy eating
Is there anything that you are worried about with your child’s eating? 

Yes  No     Details:
Document conversation about age-appropriate healthy 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)
Details:
Are there any issues about availability of food?

Yes  No     Details:		
Physical activity and screen time 
Is there anything that you are worried about with your child’s level of physical activity? 

Yes  No     Details:
Is there anything that you are worried about with your child’s level of screen time? 

Yes  No     Details:
Document conversation about age-appropriate recommendations re physical activity and screen time.
Details: 

	
Eye health
Is there anything that you are worried about with your child’s vision? 

Yes  No     Details: 
Eye examination	
Evidence of squint or other abnormality: 

R                               L
Visual acuity (child aged three to five years): 

R                               

L
Details: 

		
Ear health and hearing
Is there anything that you are worried about with your child’s listening?

Yes  No     Details: 
Is there anything you are worried about with your child’s language/talking?

Yes  No     Details: 
Do you notice snoring/noisy breathing at night/while your child is sleeping? 

Yes  No     Details: 
Last hearing test (audiology):
Ear examination
Otoscopy (video otoscopy if possible, allows for parental education and for images to be saved for tracking over time)
Otoscopy findings (may be more than one of these):		
Left ear
 Clear and intact
 Dull and intact
 Discharge
 Grommet in canal
 Grommet in eardrum
 Perforation
 Red/bulging
 Retracted
 Unable to view eardrum
 Wax
 Other:	Right ear
 Clear and intact
 Dull and intact
 Discharge
 Grommet in canal
 Grommet in eardrum
 Perforation
 Red/bulging
 Retracted
 Unable to view eardrum
 Wax
 Other:		
Tympanometry 

R                         

Yes   No   Results:
L                             Yes   No   Results:
Details: 		
Oral and dental health
Is there anything that you are worried about with your child’s teeth or mouth? 

Yes  No     Details: 
Last dental checkup: 
Teeth and mouth check 
Examination findings: 
Document conversation about oral health and care of teeth
Details:		
Skin
Does your child have any skin problems?

Yes  No     Details: 
General skin examination 
Examination findings:
Document conversation about sun protection as appropriate (ie sunscreen, hats, shade)
Details: 		
Immunisation: Check Child Health Record/Book and Australian Immunisation Register 
Immunisations up-to-date and recorded on Australian Immunisation Register (as per Australian immunisation handbook)? (PI 04)
https://immunisationcalculator.sahealth.sa.gov.au/ImmuCalculator.aspx 

Yes  No     Immunisations due: 
Vaccines given today recorded on Australian Immunisation Register? 

Yes  No
Details:		
Examination: growth measures recorded on Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) growth charts for centile and tracking overtime
Growth measures
Height: 
Weight:
Head circumference:
Heart rate and rhythm:
Cardiac auscultation:
Abdominal examination:
Gait examination (musculoskeletal structure, balance, coordination): 
Newborn examination (if indicated, infant aged ≤6 weeks):
Haemoglobin (children at risk of iron deficiency anaemia):		

Finalising the health check	
Patient priorities and goals: What does the parent/carer and child say are the important things that have come out of this health check?	
Brief intervention: Advice and information provided during health check, for example:	

 Healthy eating 	

 Screen use	

 Sun protection	

 Environmental exposure to harmful elements (eg tobacco smoke)	

 Sugary drinks	

 Physical activity and exercise	

 Parenting advice	

 Other: 	
Care provided as part of the health check (eg immunisations, medication review, investigations requested)
	
Identified needs and plan (including new diagnoses)
	
Follow-up: Consider what follow-up appointments 
can be made at the time of the health check	Reminder: MBS follow up items for clients at risk of or with chronic disease are available to support follow-up of health checks	
Referrals and appointments, for example:
Who	
When	

GP follow-up		

Aboriginal and/or Torres Strait Islander Health Worker follow-up		

Aboriginal and/or Torres Strait Islander Health Practitioner follow-up		

Practice nurse follow-up		

Dentist		

Paediatrician		

Audiology		

Speech pathology		

Mental health		

Parenting programs/support services		

Other:		
Recalls entered (eg clinical review including review of results, immunisations, investigations)	
Parent/patient actions 	
Parent/carer has been offered a copy of this health check including details of follow-up and future appointments 	

 Yes, copy taken	

 Yes, but declined 	

 Not offered. Plan to follow up and offer at a later date	

Health check claimed (PI 03)
If you would like to provide feedback on this template, please contact aboriginalhealth@racgp.org.au
© The Royal Australian College of General Practitioners June 2020
This resource is provided under licence by the RACGP. Full terms are available at www.racgp.org.au/usage/licence 
We acknowledge the Traditional Custodians of the lands and seas on which we work and live, and pay our respects to Elders, past, present and future.