GP Care Plan Template

Patient Details

Name: [Insert Patient Name] Date of Birth: [Insert Date of Birth] Medicare Number: [Insert Medicare Number] Address: [Insert Address] Phone: [Insert Phone Number]

Relevant History

[Provide a brief summary of past and current clinical history relevant to the listed conditions.] For example: - Diagnosed in [Year], currently on [Medication]. - Family history of [Condition].

Patient Needs, Goals, and Preferences

[Summarize the patient's goals, needs, and preferences related to their health management.] For example: - Improve blood sugar control - Reduce fatigue - Continue working part-time - Avoid hospital admissions

Medical Conditions (Chronic or Complex)

[List one or more chronic or complex conditions being managed under this plan.] For example: - Type 2 Diabetes Mellitus - Hypertension

Planned Management and Actions

[List the planned interventions, tests, medications, or referrals, along with the responsible provider and timeframe.] For example: Action/Service: Responsible Provider Timeframe - HbA1c every 3 months: GP Ongoing - Diabetes education Practice Nurse Within 1 month - Foot check Podiatrist Referred, book within 2 weeks - Medication review Pharmacist Next visit

Allied Health & Other Providers Involved (Team Care)

[If applicable, include the names, roles, and contact information of allied health and other providers involved in the patient's care.] For example: Provider Role Contact Info - Jane Doe Dietitian (123) 456-7890 - XYZ Clinic Physiotherapy physio@xyz.com

Patient Agreement and Understanding

(check the relevant box) ☐ Plan discussed and agreed with the patient ☐ Copy offered to patient ☐ Consent obtained to share with involved providers

Review Plan

Next review due: [Insert date, usually in 6 months] ☐ Schedule follow-up appointment

Signature

[Insert Date] GP Signature: