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Useful Doctor’s Visit Checklist


SPECIALIST APPOINTMENT PREPAREDNESS

Facilitating clear communication for ultra-rare conditions.

1. DETAILS

Childs NameDOBAppointment DateTime
          /     /          /     /          
ClinicianSpecialtyHospital/ClinicContact
                    

2. CLINICAL BRIEF: SAVI (Medical Alert)

Awareness Check: Does this doctor/clinician know my child has SAVI?

  Yes

  No

 Not Sure


3.

APPOINTMENT GOALS & OBSERVATIONS

Main Goals for this Visit:

  1.      
  2.      
  3.      

Recent Changes or Observations: (Note any new symptoms, changes in energy, or side effects) [

     ]


4. MEDICATION RECORD

Current Medications

MedicationDoseFrequencyPurpose
                    
                    
                    
                    
                    

Previous Medications / Adverse Reactions | Medication | Year | Reason for Stopping / Reaction Details | | :— | :— | :— | | [ ________ ] | [ ____ ] | [

MedicationYearReason for stopping
               
               
               
               
               

Allergies:      


5. CARE TEAM COORDINATION

Medical team

Specialist NameSpecialtyPhone/ContactLast Appt
                [     /     /     ]
               [     /     /     ]
               [     /     /     ]
               [     /     /     ]

Therapy & Supports

Therapists NameSpecialtyPhone/ContactLast Appt
                [     /     /     ]
               [     /     /     ]
               [     /     /     ]

Support Eligibility Check: Is my child eligible for:

 NDIS

 ACROD

 Education Support

 Centrelink (Carer Payment/Health Care Card/allowance/DSP):

 other supports? __________________

Will you assist with evidence for these?

Where else can we get help


6. IMPORTANT QUESTIONS

Select relevant questions to ask today:

  What changes should I tell you about immediately?

 How does this symptom relate to the SAVI condition?

 What side effects do we need to be aware of?

 How will you coordinate with the other doctors involved?

 Who should I contact if I am worried?

 What is the specific purpose of this treatment/investigation?

Notes / Plan:

[     

[     

[     

[     


7. REMINDERS FOR THE CARER

  • You are the expert: You know your child better than anyone else.
  • Your Rights: To be heard, to ask questions, to have clear information, and to seek a second opinion.
  • Requests: You can ask specialists to talk to others involved or provide a copy of clinic letters.