General Practitioner Template
Menopause & Perimenopause Health Assessment
A professional General Practitioner template for healthcare professionals.
About this template
Looking for a streamlined way to document menopause and perimenopause consultations? This Menopause & Perimenopause Health Assessment template is designed for GPs and other clinicians. It helps you efficiently capture patient history, symptoms, examination findings, and management plans. With Heidi, this template can be quickly populated from your consultation transcript, saving you time and ensuring comprehensive documentation. This template is perfect for creating detailed and accurate medical records, and is a great tool for any GP looking to improve their documentation process.
Preview template
S – Subjective (Patient History)
* Patient reports experiencing hot flushes and irregular periods for the past 6 months.
* Menopausal status:
* ✓ Perimenopausal
* Symptoms reported:
* ✓ hot flushes
* ✓ irregular periods
* Impact on daily life and wellbeing:
* Reports sleep disturbance due to night sweats.
* Experiencing mood changes, including increased irritability.
Medical history:
* Chronic conditions:
* Nil reported.
* Surgical history:
* Appendectomy at age 12.
* Family history:
* Mother diagnosed with breast cancer at age 60.
Reproductive history:
* Age at menarche:
* 13 years old.
* Parity:
* G2P2.
* Contraceptive history:
* Used combined oral contraceptive pill for 10 years, ceased 2 years ago.
Medication history and allergies:
* Current medications:
* Nil.
* Allergies:
* No known allergies.
Contraindications to treatment:
* Nil reported.
O – Objective (Examination & Investigations)
Vital signs:
* Blood pressure in mmHg:
* 130/80 mmHg.
* Height in cm:
* 165 cm.
* Weight in kg:
* 70 kg.
* BMI:
* 25.8 kg/m².
Physical examination:
* General examination findings:
* Patient appears well.
* Gynaecological examination findings:
* Not performed.
Investigations initiated:
* ✓ Cervical screening (if due)
* ✓ Blood tests (FSH, Estradiol, TSH, Lipids, Vitamin D, others)
Referrals made:
* ✓ Gynaecologist
A – Assessment
"Menopause/perimenopause health assessment in accordance with MBS Item 695."
* Symptoms consistent with:
* ✓ Perimenopause
P – Plan
Management discussion:
Non-pharmacological options:
* ✓ lifestyle changes
* ✓ sleep strategies
Pharmacological options:
* ✓ MHT/HRT (benefits and risks discussed)
Patient-centred management plan:
* Symptom management agreed:
* Trial of low-dose HRT discussed and agreed upon.
* Follow-up arranged:
* Review in 3 months.
* "Discussed shared decision-making"
Preventative care advice:
* ✓ physical activity
* ✓ weight management
Eligibility check:
* ✓ No Item 695 claimed in last 12 months
* ✓ Patient meets criteria.
Billing:
MBS Item: "695 – Menopause/Perimenopause Assessment"
[Date of assessment]: 1 November 2024
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Specialty
General Practitioner
Used
20 times
Type
Note
Last edited
6/10/2025
Created by
Rozal Dalit