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	

 Early learning centre	

 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):					
Child has a birth certificate:					
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:
Does your child have a Child Health Book?  Yes No 

Is it up to date?			         Yes 	 No		
Learning and development 
Is there anything that you are worried about with your child’s development?

Yes  No   Details: 
Is there anything that you are worried about with your child’s behaviour?

Yes  No   Details: 
Is there anything that you are worried about with your child’s sleep?

Yes  No   Details: 
What childcare/early learning centre/kindergarten does your child go to? How often?
Details: 
How often does your child miss childcare/early learning centre/kindergarten?
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: 		
Medical history and current problems
Gestation at birth (weeks): 
Birth weight (PI 01, PI 02, QI M3): 
Pregnancy complications 

Yes  No     Details:
Birth complications 

Yes  No     Details:
Problems after birth 

Yes  No     Details:
Hospital admissions 

Yes  No     Details:
Any of the following?

 Recurrent cough or chest infections

 Recurrent ear infections/CSOM (glue ear/grommets)

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

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

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

Do you 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: 

		
Feeding and healthy eating
Is there anything that you are worried about with your child’s feeding/eating?

Yes  No     Details:
Breastfeeding history
Details: 
Bottle feeding history
Details: 
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
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: 

		

Table 1. Red flags early identification guide for children aged six months to five years	
	6 months	9 months	12 months	18 months	2 years	3 years	4 years	5 years	Red flags at any age	
Social emotional	

Does not smile or interact with people	

Not sharing enjoyment with others using eye contact or facial expression	

Does not notice someone new

Does not pay early turn taking games (eg peekaboo, rolling a ball)	

Lacks interest in playing and interacting with others	

When playing with toys tends to bang, drop, or throw them rather than use them for their purpose (eg Cuddle doll, build blocks)	

No interest in pretend play or interacting with other children

Difficulty noticing and understanding feelings in themselves and others (eg happy, sad)	

Unwilling or unable to play cooperatively	

Play is different than their friends	

Strong parental concerns

Significant loss of skills

Lack of response to sound or visual stimuli

Poor interaction with adults or other children

Lack of, or limited eye contact

Differences between right and left sides of body in strength, movement or tone

Marked low tone (floppy) or high tone (stiff and tense) and significantly impacting on development and functional motor skills	
Communication	

Not starting to babble (eg aahh, oohh)	

Not using gestures (eg pointing, showing, waving)

Not using two part babble (eg bubu, dada)	

No babbled phrases that sound like talking

No response to familiar words (eg bottle, daddy)	

No clear words

Cannot understand short requests (eg ‘Where is the ball?’)	

Not learning new words

Not putting words together (eg ‘push car’)	

Speech is difficult for familiar people to understand

Not using simple sentences (eg big car go)	

Speech difficult to understand

Not able to follow directions with two steps (eg ‘Put your bag away and then go play’)	

Difficulty telling a parent what is wrong 

Not able to answer questions in a simple conversation (eg What’s your name? Who is your family?)		
Cognition, fine motor and 
self care	

Not reaching for and holding (grasping) toys

Hands frequently clenched

Does not explore objects with hand and mouth

Does not bring hands together at midline	

Does not hold objects

Does not ‘give’ objects on request

Cannot move toy from one hand to another	

Does not feed self finger foods or hold own bottle/cup

Unable to pick up small items using index finger and thumb	

Does not scribble with a crayon

Does not attempt to stack blocks after demonstration	

Does not attempt to feed self using a spoon and/or help with dressing	

Does not attempt everyday care skills (such as feeding or dressing)

Difficulty in manipulating small objects (eg threading beads)	

Not toilet trained by day 

Not able to draw lines and circles	

Concerns from teacher about school readiness

Not independently able to complete everyday routines such as feeding and dressing 

Cannot draw simple pictures (eg stick person)		
Gross motor	

Not holding head and shoulders up with good control when lying on tummy 

Not holding head with good control in supported sitting	

Not rolling

Not sitting independently/
without support

Not moving (eg creeping, crawling)

Not taking weight on legs when held in standing	

No form of independent mobility (eg crawling, commando crawling, bottom shuffle)

Not pulling to stand independently and holding on for support	

Not standing independently

Not attempting to walk without support	

Not able to walk independently 

Not able to walk up and down stairs holding on	

Not able to walk up and down stairs independently

Not able to run or jump	

Not able to walk, run, climb, jump and uses stairs confidently

Cannot catch, throw or kick a ball 	

Not able to walk, run, climb, jump and use stairs confidently

Not able to hop five times on one leg and stand on one leg for five seconds		
Reproduced with permission from Queensland Government. 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].

Assessment	Health priorities, actions and follow-up	
Eye health
Is there anything that you are worried about with your child’s vision? 

Yes  No     Details: 
Eye examination	
Red reflex (up to six months): 
R                             L 
Evidence of squint or other abnormality: 
R 

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

                         

   L 

		
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: 
Date of 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:		

Assessment	Health priorities, actions and follow-up	
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)? (PI04)
https://immunisationcalculator.sahealth.sa.gov.au/ImmuCalculator.aspx 

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

Yes  No		
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		
Length/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 say are the important things that have come out of this health check?

Brief intervention: Advice and information provided during health check, for example:	

 Sugary drinks	

 Screen use 	

Healthy eating, 
including breastfeeding 	

Environmental exposure to harmful elements eg tobacco smoke 	

Physical activity and exercise 	

 Sun protection	

Parenting advice	

  Safe sleeping practices	

Developmental milestones – including language and hearing	

 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		

Child health nurse		

Dentist		

Paediatrician		

Audiology		

Speech pathology		

Mental health		

Early intervention (development) services		

Parenting programs/support services		

Other:

Recalls entered (eg clinical review including review of results, immunisations, investigations)
	
Parent/carer 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.