Health Review Checklist (PDF) pdf format of    health-checklist-hc2.pdf  doc format of health-checklist-hc2.doc

The Health Review Checklist was created to help inform the primary health care provider about health issues and changes. It helps to provide consistent, relevant and thorough health status information to the treating provider at the time of the medical encounter.

The Health Review Checklist is generally completed by direct support professionals. The tool asks direct support professionals who interact most directly with individuals on a day-to-day basis to respond to questions about easily observable indicators of health or illness. It does not require that staff make any clinical judgments, only that they observe and record what they see.

The Checklist is required for use in preparation for the annual physical exam as well as for any visit to the individual's primary care provider. It is not required for use in preparation for specialty visits, unless the provider feels such use would be helpful. This checklist can also be used at regular intervals to monitor specific conditions or to note changes in health status.

While the checklist was developed primarily with the direct support professional in mind, it can also be used by family members or other provider staff to help prepare for a consultation or visit with a health care provider.

Where to file the Health Review Checklist after the visit:
The Health Review Checklist should be filed with the health care provider encounter or visit form that was completed at the visit with the health care provider.


This information is provided by the Department of Developmental Services.