Burnham Health Centre

Update your clinical record

Clinical practice forms – submitted to the practice only on request

We may periodically ask you to submit a form to the practice with some health-related information to help us update your clinical record. Please only submit these forms if you are asked to by the practice.

These forms may include:

The universal medication review form

We may ask you to complete this form for any medication review, particularly an annual review. It is helpful if you also complete any relevant quality care check lists (explained below) before completing this form.
Complete and submit the online form:

The health data form

We may ask you to complete this form if we only want information on your blood pressure, weight, smoking or alcohol.
Complete and submit the online form:

The long term conditions interval review form

We may ask you to complete this form between annual medication reviews particularly if you are on blood pressure medication.
Complete and submit the online form:

Other forms we may occasionally ask you to complete and submit to the practice are included below:

We may ask you to download and complete a form.  This might include forms for:

Epworth Sleepiness Scale

The Epworth Sleepiness Scale is used to help diagnose obstructive sleep apnoea (OSA). Asthma + Lung UK provide a calculator version of the questionnaire (under license) which you can print off:

International Prostate Symptom Score (I-PSS)

The International Prostate Symptom Score (I-PSS) is a symptom score is used by a clinician to better understand the severity of your prostate symptoms. The form is explained in context by The British Association of Urological Surgeons (BAUS) Prostate symptoms (bladder outlet obstruction) | The British Association of Urological Surgeons Limited. Your GP may ask you to complete. BAUS provide a PDF version you can download and complete:

Quality care checklists and local support

Quality care checklists are a form with a series of health questions and answers but unlike many forms, checklists are not submitted back to the practice when you complete them. They are for your own use to help you develop a better understanding of your condition(s), including where relevant, options with local support.

These checklists can be completed at any time but we do ask that you complete any relevant checklist before a medication review (particularly your annual review) to help you get the most out of your medication review.

We include a list of all the quality care checklists and a further explanation of checklists below:

Remember that these checklists are not submitted to the practice though we may ask to you add scores/ numbers to the “universal medication review” form from these checklists.

If you have a long-term condition you should start with completing the “long-term condition and medication” checklist.

Long-term conditions and medication checklist

This checklist covers features which are common to many long-term conditions which are not duplicated in the other checklists.

Other checklists

Review any checklist(s) which are relevant to you.

Medical Conditions

Mental Health

Lifestyle Risk Factors

Medication 

Some Important Patient Groups

Some Important Decisions

Introduction
Quality care checklists are a form with a series of questions but unlike some other practice forms these forms are not submitted back to the practice when you complete them. They are for your own use to help you develop a better understanding of your condition(s), including where relevant options with local support.

How to use them
Many will use quality care checklists just for information or may access local services without ever needing to attend their GP practice. Some will use a checklist to support a conversation they will have with a practice clinician. Some will use a checklist after a practice consultation to follow up on an action that was discussed in a consultation.

What individual patients do with a checklist will be variable. Some will do nothing on the checklist but they will have developed a broader understanding and may consider some of the options in the future, some will do everything relevant on the list.

What type of questions do checklists ask
Quality care checklists fundamentally ask 4 key questions of patients to help them with their care.

  1. Are you aware about an aspect of your condition?  May include
    Broad aspects (e.g., what lifestyle risk factors are relevant for your condition) or
    Specific points about your condition? (e.g., What the range of your target blood test value might be for your condition)
  2. Would this option be helpful to you? May include
    Local support (e.g., direct access to mental health psychological support) or
    A practice option (e.g., online access to your investigations)
  3. How can you be better protected and made safer? (e.g., if you potentially are at a higher risk of sepsis providing information on how you can detect sepsis early)
  4. How can you plan for potential future events? (e.g., a care plan)

Not all quality care checklists will cover all 4 questions, but may just focus on one such as safety.

Other ways to contact us with health monitoring

You can also tell us

  • By email: You can email your health data to the practice.
  • In person: You can drop in your health data into our post box or directly to reception.
  • By post: You can post your health data to us.

Our email and address can be found under

Update your personal details

If you need to update your personal details such as a change of contact details (e.g., telephone number or address) or if you are a carer or veteran or want to consent to communication by texts/ emails use the form under

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