GP EATING DISORDER PLAN (EDP)
Item No : 90250 - 90257

PATIENT DETAILS
RE: <<Patient Demographics:First Name>> <<Patient Demographics:Surname>>	   DOB: <<Patient Demographics:DOB>>	 Age: <<Patient Demographics:Age>>
Preferred Name: 
Current Gender Identity: <<Patient Demographics:Gender>>
IHI No.: <<Patient Demographics:IHI>>
Address: <<Patient Demographics:Full Address>>
Home Phone: <<Patient Demographics:Phone (Home)>>
Mobile Phone: <<Patient Demographics:Phone (Mobile)>>
Medicare No.: <<Patient Demographics:Medicare Number>> 	Expiry: <<Patient Demographics:Medicare Expiry Date>>
DVA No.: <<Patient Demographics:DVA Number>>			Card Type: <<DVA Card Type>>
Marital Status: <<Patient Demographics:Marital Status>>

Preferred Language: <<Patient Demographics:Language Preferred>>
Interpreter required: <<Interpreter required? >>
Ethnicity: <<Patient Demographics:Ethnicity>>
ATSI Status: <<Patient Demographics:ATSI>>
Country of Birth: <<Patient Demographics:Country of Birth>>
Family/ support person details: (Consider involving support person in session if appropriate) 
<<Family/ support person details>>
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GP DETAILS
GP Name: <<Doctor:Name>>
Provider Number: <<Doctor:Provider Number>>
Practice Name: <<Practice:Name>>
Practice Address: <<Practice:Address>>
Practice Phone: <<Practice:Phone>>
Practice Fax: <<Practice:Fax>>
GP or Practice emails: <<Practice:E-mail>>

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RECORD OF PATIENT CONSENT
I (GP) have discussed the proposed referral(s) with the patient and am satisfied that the patient understands the proposed uses and disclosures and has provided their informed consent to these: <<GP consent>>

GP Name: <<Doctor:Name>>
Date: <<Miscellaneous:Date (short)>>

Copy of EDP given to Patient: <<Copy of EDP given to Patient?>>

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ELIGIBILITY FOR EDP
Eating Disorder Diagnosis (DSM-V):<<Eating disorder diagnosis>> (https://insideoutinstitute.org.au/resource-library/dsm-5-diagnostic-criteria-for-eating-disorders)

EDE-Q Global Score: (score ³ 3 for eligibility) <<EDE-Q Global Score>>

Eating Disorder Behaviours: (at least 1 for EDP eligibility) <<EATING DISORDER BEHAVIOURS (at least 1)>>

Clinical Indicators: (at least 2 for EDP eligibility) <<Clinical Indicators (at least 2 for EDP eligibility)>>

Detail to Clinical Indicators: <<Detail to Clinical Indicators>>
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MENTAL HEALTH ASSESSMENT & HISTORY
Past Medical History: <<Clinical Details:History List>>
Previous specialist mental health care: <<Previous specialist mental health care?>>
Family History of Mental Illness: <<Family History of Mental Illness?>>
<<Clinical Details:Family History>>
Social history: <<Clinical Details:Social History>>
Personal History: <<Personal history>>
Appearance and General Behaviour: <<Appearance and General Behaviour>>
Mood: (Depressed/Labile) <<Mood: (Depressed/Labile)>>
Thinking: (Content/Rate/Disturbances) <<Thinking (Content/Rate/Disturbances)>>
Affect: (Flat/blunted) <<Affect  (Flat/blunted)>>
Perception: (Hallucinations etc.) <<Perception (Hallucinations etc.)>>
Sleep: (Initial Insomnia/Early Morning Wakening) <<Sleep (Initial Insomnia/Early Morning Wakening)>>
Cognition: (Level of Consciousness/Delirium/Intelligence) <<Cognition (Level of Consciousness/Delirium/Intellig>>
Appetite: (Disturbed Eating Patterns) <<Appetite  (Disturbed Eating Patterns)>>
Attention/Concentration: <<Attention/Concentration>>
Motivation/Energy: <<Motivation/Energy>>
Memory: (Short and Long Term) <<Memory (Short and long term)>>
Judgement: (Ability to make rational decisions) <<Judgement  (Ability to make rational decisions)>>
Insight: <<Insight>>
Anxiety Symptoms: (Physical & Emotional) <<Anxiety Symptoms  (Physical & Emotional)>>
Orientation: (Time/Place/Person) <<Orientation (Time/Place/Person)>>
Speech: (Volume/Rate/Content) <<Speech  (Volume/Rate/Content)>>
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PHYSICAL EXAMINATION
Height: <<Clinical Details:Measurements>>
Weight: <<Clinical Details:Measurements>>
Body Mass Index (BMI): <<Clinical Details:Measurements>>
Physical Assessment: <<Physical assessment notes>>
Laboratory Investigations: <<Summary:Investigation Results (Selected)>>

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RISK ASSESSMENT
Suicidal ideation: <<Sucicidal ideation?>>
Suicidal intent: <<Suicidal intent?>>
Current plan: <<Current plan>>
Risk to others: <<Risk to others?>>

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INITIAL TREATMENT RECOMMENDATIONS UNDER EDP
Psychological treatment services (EDPT): (Initial 10 sessions) 
RE: <<Psychological treatment services (EDPT) RE>>

Dietetic services: (up to 20 in 12 months)
RE: <<Dietetic services RE>>

Psychiatric/paediatric review: (Assessment by psychiatrist/ paediatrician required for patient to access EDPT sessions 21-40)
RE: <<Psychiatric/paediatric review RE>>

GP REVIEW REQUIREMENTS
Mental Health: <<Mental health:>>
Dietetics: <<Dietetics:>>
Psychiatric or Paediatric Review: <<Psychiatric or Paediatric Review: <Required in addi>>
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APPENDIX
EATING DISORDERS PATIENT PHYSICAL ASSESSMENT

SUGGESTED INITIAL PHYSICAL ASSESSMENT

Height, weight, body mass index (BMI; adults), BMI percentile for age (children)

Pulse and blood pressure, with postural measurements

Temperature

Assessment of breathing and breath (eg ketosis)

Examination of periphery for circulation and oedema

Assessment of skin colour (eg anaemia, hypercarotenaemia, cyanosis)

Hydration state (eg moisture of mucosal membranes, tissue turgor)

Examination of head and neck (eg parotid swelling, dental enamel erosion, gingivitis, conjunctival injection)

Examination of skin, hair and nails (eg dry skin, brittle nails, lanugo, dorsal finger callouses [Russell’s sign])

Sit-up or squat test (ie a test of muscle power)

USEFUL LABORATORY INVESTIGATIONS

Full blood count

Urea and electrolytes, creatinine

Liver function tests

Blood glucose

Urinalysis

Electrocardiography

Iron studies
B12, folate
Calcium, magnesium, phosphate

Hormonal testing – thyroid function tests, follicle stimulating hormone, luteinising hormone, oestradiol, prolactin

Plain X-rays – useful for identification of bone age in cases of delayed growth
Bone densitometry – relevant after 9–12 months of the disease or of amenorrhoea and as a baseline in adolescents. The recommendation is for two-yearly scans thereafter while the DEXA scans are abnormal.