Health Passport Summary Format

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It is vital to make a legible record in the patient health passport every time you review them. This will help you and any other practitioner the next time this patient is reviewed.

IMPORTANT: Ensure the patient identifying information on the health passport is recorded correctly (ie Name, DOB, Address, District, Contact number, Guardian’s name and contact numbers)

Any review of a patient should record information under each of the following headings:

  1. Age of Patient
  2. Previous working diagnosis
  3. List of Physical Comorbidities (if any)
  4. Current medications and dose
  5. Brief Summary of patient’s complaints, symptoms or progress since the last review
  6. Collateral information (if any)
  7. Brief description of patient’s current functionality (working, in school, social relationships etc)
  8. Brief report on psychotropic drug side effects (if any)
  9. Key Mental State Findings
  10. Assessment i.e current diagnosis or working diagnosis
  11. Plan of management
    • If medication prescribed – Dose, route of administration, frequency, duration of treatment clearly indicated
    • Next appointment date

Record the date, location and health worker’s name and signature.