Social and emotional wellbeing review template 	
MBS item number:   ☐ 2712    	
Date for review with a GP (dd/mm/yyyy)
(Initial review four weeks to six months after completion of the plan)

Assessment/outcome tool results on review (except where clinically inappropriate or culturally unsafe)
		
Comments: Review of patient’s progress against goals; checking, reinforcing and expanding education; modification of treatment plan (if require ed); any changes in medication; and any recent significant stressors or lifestyle changes
Comments from carers and relatives about how the patient is tracking

Comments from the Aboriginal Health Worker

Changes in the patient’s circumstances (eg work, family, social connectiveness) 
		
Risk assessment: Note any identified risks, including risks of self-harm, risk of suicide and harm to others.

Also consider risk of:
•	Domestic family violence
•	Intimate partner abuse/violence
		
Plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided