Gp Management Plan And Tca
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3Hcn Samples Database
1 New Street
Bowen Hills Qld 4006
GP MANAGEMENT PLAN and TCA - MBS ITEM No. 721/723
Patient's Name: Joan
Age: 73
Patient’s Name: Joan
Date of Birth: 1941
Contact Details:
Medicare or Private Health Insurance Details:
1Health Highway
4133 40027 1 / 5
Gold Coast
No Insurance
Details of Patient’s Usual GP:
Details of Patient’s Carer (if applicable):
Dr. A. Practitioner
Name:
13 Best St.
Relationship to Patient:
PILL LAND
4000
Tel:
Provider No: 2426621B
Tel (work): 07 7878 7878
Date of last GP Management Plan/TCA (if done):
Phone Medicare (PH: 132150) if not sure of eligibility
Other notes or comments relevant to the patient’s Management Plan/TCA: Identify and record patient overall goals – may not have a clinical focus
“I would like to be able to attend my grandsons wedding in 6 months’ time and be able to have a dance with him. To do
this I will need to increase my level of activity”
PAST MEDICAL HISTORY
Active:
Inactive:
Condition – Comment Gestational Diabetes
Date
1961
Condition – Comment
Date
2014
Type 2 Diabetes
Type 2 Diabetes
2008
COPD
COPD
2006
Hypertension
Hypertension
2008
Osteoarthritis
Osteoarthritis
Hypercholestrolaemia
2010
Hypercholestrolaemia
FAMILY HISTORY
Father – IHD, deceased age 63
Mother- Type 2 diabetes aged in 50’s
SOCIAL HISTORY
Married, husband‘s name is Tom. Tom has early dementia and Joan has just recently applied for carers’ allowance.
Two married children with 6 grandchildren, living on the Gold Coast
MEDICATIONS
Celebrex 200mg daily
Atorvastatin 20mg daily
Ezetemide 10mg daily
Olmatec
Metformin (newly prescribed)
ALLERGIES Nil known
VACCINATIONS Nil recorded
(check if accurate)
Smoking status: Smoker 10-15/day
Alcohol: Nil
Patient’s Name: Joan
GP MANAGEMENT PLAN and TCA - MBS ITEM No. 721/723
##### Record problems and goals from a patient perspective
Patient problems / needs /
Goals - changes to be achieved
Required treatments and services including
Arrangements for
relevant conditions
patient actions
treatments/services (when,
who, contact details)
1. General
Better understanding of my
To have a clear understanding of my conditions
Patient education: Diabetes educator,
GP to complete Referrals to:
condition/s
and my role in keeping well, to be achieved over
Respiratory Nurse specialist
Diabetes Educator (private or
the next 12 months
Patient to attend appointments
Community Health), Group Allied
GP and PN reviews and support
Health Services, Respiratory
Group Allied health education (exercise
Services at QLD Community
Physiologist)
Health (referrals send ASAP)
PN/GP : review and support –
Endocrinologist/ Respiratory Physician
monthly
Diabetes Australia Membership/
NDSS application
Pulmonary Rehabilitation
Program
Learn how to cope with changes
To access support when needed, learn who is
Social worker and/or Self- management course
GP to complete referrals to Social
available – to be achieved over the next 12
worker( community health, NGO –
in my life
Patient to book and attend appointments
months
eg Blue Care
and/or Anglicare self-
management course (transport
will be provided if required)
Consider Carer support groups for
dementia
2. Lifestyle
Dietitian review – to complete assessment and
Nutrition
to learn about healthy foods and how to improve
GP to complete referral to
my diet over the next 12 months
provide healthy eating options
Dietitian (private OR Community
Patient to attend appointments
Health)
Consider healthy eating activities
at GC Libraries
Weight: 97kg
Not to gain any more weight.
Education: from Dietitian, Diabetes educator,
GP to complete referrals (add
BMI: 35.6
To lose 1-2kg/month over next 6 months
GP and PN
details here if not already
I will attend appointments and work towards
mentioned in sections above)
goals
Physical activity
Walk to letter box daily in first month
Consider Exercise physiologist group session
GP to complete referrals to:
Walk to buy newspaper at corner shop 3xweek in
Review local exercise programs and suitability
Exercise physiologist (individual
3 months’ time
(gentle classes for seniors run by GCCC,
or group), physiotherapist (private
Patient Name: Joan
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