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General Practitioner Template

Older Person's Health Assessment - Health Assessment Questionnaire (HAQ)

A professional General Practitioner template for healthcare professionals.
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About this template

Need a comprehensive assessment for your elderly patients? This Older Person's Health Assessment template is perfect for General Practitioners (GPs) and other healthcare professionals. It helps streamline the process of evaluating physical, psychological, and social function, medication reviews, and preventive health measures for patients aged 75 and over. This template, when used with Heidi, ensures all key areas are covered, from ADLs to immunisation status, making documentation efficient and thorough. Easily document agreed plans and follow-up reviews. Simplify your older person's health assessments with this essential template.

Preview template

**Older Person’s Health Assessment (≥75 years)** Date: 01/11/2024 Doctor: Dr. Emily Carter, GP Patient: Mrs. Agnes Davies DOB: 12/03/1938 Today I conducted an Older Person’s Health Assessment for Mrs. Agnes Davies, aged 86. They consent to the plan being performed and have been offered a copy of the plan. Function (Physical, Psychological & Social): - Physical function: Mrs. Davies reports some difficulty with mobility, particularly getting up from a chair. She manages ADLs independently, but with some slowing. No falls reported in the last 3 months. - Cognition and mood: MMSE score of 28/30, indicating mild cognitive impairment. Reports feeling low in mood recently. - Social supports and caring responsibilities: Lives alone, but has regular visits from her daughter and receives some support with shopping and housework. Examination & Screening: - BP: 140/80 mmHg - Pulse rate: 72 bpm, regular rhythm - Immunisation status: Up to date with influenza and pneumococcal vaccines. Medication Review: - Current medications: Lisinopril 10mg daily, Amlodipine 5mg daily, Simvastatin 20mg nocte. Adherence is good. No reported side effects. No known interactions. Deprescribing considerations discussed for Simvastatin due to age and frailty. Not webster packed. Preventive Health: - Preventive health advice: Encouraged to continue with regular exercise and social activities. Discussed importance of good nutrition. - Vaccinations: Up to date with influenza and pneumococcal vaccines. - Education offered: Provided information on local support services for older adults. - Referrals if indicated: Referred to a social worker for assessment of social support needs. - GP Chronic Conditions Plan: In place, due for review in 6 months. Management Plan & Reporting: - Summary of agreed plan: Continue current medications, review Simvastatin in 3 months. Referral to social worker. Encourage regular exercise and social activities. - Written report provided to patient. "Review of Plan: 12 months" Next clinical review due: 6 months
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Specialty

General Practitioner

Used

20 times

Type

Note

Last edited

6/11/2025

Created by

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