Down s Syndrome Association
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1 Trim x mm twitter.com/dsainfo Down s Syndrome Association Down s Syndrome Association twitter.com/dsainfo Down s Syndrome Association Down s Syndrome Association covers 2014.indd 1 21/01/ :58
2 My Health Checks
3 About this health book Each page of this health book is available as a download from DSA s website when replacement pages are needed. Owner of the Health Book This health book will help you and your GP to look after your health You can ask someone for help to make sure all the right information goes into the book Remember to take this health book with you when you go to see your GP You should have a health check at least once every year If your GP does not offer annual health checks, ask him/her to tell you the name of a local GP who does You can get information about adult annual health checks from the DSA It is important for us to hear what you think about the health book. You can tell us what you think about the health book by info@downs-syndrome.org.uk GPs This health book is a tool to guide you through the health conditions that are more typically seen in people with Down s syndrome It may be used during an annual adult health check or a general appointment It is not a step by step guide to carrying out an adult health check as that information already exists in other formats health information at We would very much like to hear what you think of the health book and GP website. Please send your feedback to: info@downs-syndrome.org.uk
4 All About Me Name: your photo Date of Birth: NHS Number: Address: My Contacts Emergency Contact: Name: Telephone: Address: Mobile: Family, friends and carers who help me with my health: Name: Address: Telephone: Mobile: Name: Address: Telephone: Mobile: Name: Address: Telephone: Mobile: My next of kin is: Name: Telephone: Address: Mobile:
5 My Contacts GP: Name: Address: Telephone: Other Health Professionals who help me with my health: Name: Role: Address: Telephone: Name: Role: Address: Telephone: Name: Role: Address: Telephone:
6 Before we start important things that you need to know about me I have these allergies: I have these phobias / I am afraid of these things: (e.g. needles, plasters) I take these medicines every day: I sometimes take these medicines:
7 Other things you need to know including family health conditions: To Communicate I use: (Tick the boxes that apply) Comments My voice Pictures Signs I do understand what you say I don t understand what you say Consent These are the people you can talk to about my health: (e.g. parents/carers, support workers) These are the people who I DO NOT want you to talk to about my health: (e.g. parents/carers, friends, support workers)
8 This is about things I need help with Tick if you need help with Tick if you need help with any of these things. any of these things 2016 Tick if you need help with any of these things. Write a little bit about this. Write a little bit about this. Write a little bit about this. Washing Dressing Going to the toilet Eating Drinking
9 This is about things I need help with Tick if you need help with any of these things. Write a little bit about this. Tick if you need help with any of these things Write a little bit about this. Tick if you need help with any of these things. Write a little bit about this. Travelling Walking Writing Reading Taking Medicine
10 This is about my visits to the Hospital Name of hospital Date of visit Reason for my visit to hospital Who I saw at the hospital/name of doctor/consultant What happened at the hospital/ outcomes
11 This is about my health My Weight is My Body Mass Index (BMI) My Height is I smoke yes/no I drink this much alcohol This is the exercise that I do I have had these vaccinations / injections Date Completed By Whom Relationship to patient
12 These are my health issues Tick Write more about this health problem here GP information available at Checked Yes/No Tests undertaken & comments Ears Eyes Skin / Nails Heart Blood Pressure Cholesterol Bones / Muscles / Joints
13 These are my health issues Tick Write more about this health problem here GP information available at Checked Yes/No Tests undertaken & comments Teeth Neck Instability Sleep Breathing Seizures Coeliac Disease Going to the toilet Periods
14 GP information available at These are my health issues Tick Write more about this health problem here Checked Yes/No Tests undertaken & comments Contraception Diabetes Thyroid Depression Worry Vitamin B12
15 GP information available at These are my health issues Problem with swallowing Tick Write more about this health problem here Checked Yes/No Tests undertaken & comments Memory - Forgetting things Gait - walking about - Moving If these issues are arising in conjunction with skill loss, weight loss, withdrawal go to:
16 Other health issues: Further information:
17 My next annual appointment is on: Date in 2015: Date in 2016: Date in 2017: Completed by: Name of GP: Address of surgery: Date: Signature:
18 twitter.com/dsainfo Down s Syndrome Association Down s Syndrome Association twitter.com/dsainfo Down s Syndrome Association Down s Syndrome Association covers 2014.indd 1 21/01/ :58
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