Author: Jenaya Price

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: Patient Demographics.Popular Name
Current Gender Identity: Patient Demographics.Gender
IHI No.: Patient Demographics.IHI Number
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:  preferred language 
Interpreter required: «CUSTOMFIELD|488002|B|interpreter require»
Ethnicity: Ethnicity
ATSI Status: «PatientDemographics.ATSIStatus»
Country of Birth: «CUSTOMFIELD|488004|C|Country of Birth|Co»
Family/ support person details: (Consider involving support person in session if appropriate) «CUSTOMFIELD|488005|C|Support Person Deta»

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GP DETAILS
GP Name: Treating Doctor.Name
Provider Number: Treating Doctor.Provider Number
Practice Name: Practice.Name
Practice Address: Practice.Address
Practice Phone: Practice.Phone
Practice Fax: Practice.Fax
GP or Practice emails: Treating Doctor.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: «CUSTOMFIELD|491000|L|Patient Consent|Pat»

GP Name: Treating Doctor.Name
Date: Miscellaneous.Date

Copy of EDP given to Patient: «CUSTOMFIELD|488007|B| EDP given to Patie»

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ELIGIBILITY FOR EDP
Eating Disorder Diagnoses (DSM-V): «CUSTOMFIELD|488008|L|Eating Disorder Dia»

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

Eating Disorder Behaviours: (at least 1 for EDP eligibility)
1.«CUSTOMFIELD|489019|L|EATING DISORDER BEH»
2. Eating disorder beha
3. Eating disorder beha

Clinical Indicators: (at least 2 for EDP eligibility)
1.. Clinical Indicators:
2. Clinical indicators
3. Clinical indicators

Detail to Clinical Indicators: «CUSTOMFIELD|489021|C|Detail to Clinical »

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MENTAL HEALTH ASSESSMENT & HISTORY
Past Medical History: Clinical Details.Past History
Previous specialist mental health care: «CUSTOMFIELD|489016|L|Previous MH Care|Pr»
Family History of Mental Illness: «CUSTOMFIELD|489017|C|Family MH History|F»
Clinical Details.Family History
Social history: Clinical Details.Social History
Personal History: «CUSTOMFIELD|489018|C|Personal History|Pe»
Appearance and General Behaviour: «CUSTOMFIELD|489000|C|Appearance & Beh|Ap»
Mood: (Depressed/Labile) «CUSTOMFIELD|489001|C|Mood: (Depressed/La»
Thinking: (Content/Rate/Disturbances) «CUSTOMFIELD|489002|C|Thinking|Thinking (»
Affect: (Flat/blunted) «CUSTOMFIELD|489003|C|Affect|Affect  (Fla»
Perception: (Hallucinations etc.) «CUSTOMFIELD|489004|C|Perception|Percepti»
Sleep: (Initial Insomnia/Early Morning Wakening) «CUSTOMFIELD|489005|C|Sleep|Sleep (Initia»
Cognition: (Level of Consciousness/Delirium/Intelligence) «CUSTOMFIELD|489006|C|Cognition|Cognition»
Appetite: (Disturbed Eating Patterns) «CUSTOMFIELD|489007|C|Appetite|Appetite (»
Attention/Concentration: «CUSTOMFIELD|489008|C|Attention/Concentra»>
Motivation/Energy: «CUSTOMFIELD|489009|C|Motivation/Energy|M»
Memory: (Short and Long Term) Memory
Judgement: (Ability to make rational decisions) «CUSTOMFIELD|489011|C|Judgement|Judgement»
Insight: «CUSTOMFIELD|489012|C|Insighy|Insight|100»
Anxiety Symptoms: (Physical & Emotional) «CUSTOMFIELD|489013|C|Anxiety Symptoms|An»
Orientation: (Time/Place/Person) «CUSTOMFIELD|489014|C|Orientation|Orienta»
Speech: (Volume/Rate/Content) «CUSTOMFIELD|489015|C|Speech|Speech  (Vol»

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PHYSICAL EXAMINATION
Height: Current Measurements.Physical - Height
Weight: Current Measurements.Physical - Weight
Body Mass Index (BMI): Current Measurements.Physical - Body Mass Index
Physical Assessment: «CUSTOMFIELD|489022|C|Physical assessment»
Laboratory Investigations: Clinical Details.Result List (Selected)

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RISK ASSESSMENT
Suicidal ideation: Sucicidal ideation?
Suicidal intent: «CUSTOMFIELD|491002|B|Suicidal intent?|Su» 
Current plan: «CUSTOMFIELD|491003|B|Current plan|Curren»
Risk to others: Risk to others

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

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

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

GP REVIEW REQUIREMENTS
Mental Health: «CUSTOMFIELD|489030|L|Mental health: Prio»
Dietetics: Dietetics: after Ses
Psychiatric or Paediatric Review: «CUSTOMFIELD|489032|L|Required in additio»

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