GP EATING DISORDERS PLAN (EDP)    
Item Nos: 90250 - 90257

GP DETAILS	
GP Name
Provider No.	 <UsrName>
<DrProviderNo>	Practice Name & address	<Practice>
<DrStreet>
<DrCity>
<DrState>

Practice postcode	 <DrPostcode>	Practice phone 	<DrPhone>	Practice fax	 <DrFax>	
PATIENT DETAILS	
First Name	 <PtFirstName>	Last Name	 <PtSurname>	
Date of Birth	 <PtDoB>	Age 	<PtAge>	
Marital Status	☐ Never Married     ☐ Widowed     ☐ Divorced     ☐ Separated     ☐ Married/De facto          	
Current Gender Identity	☐ Female ☐ Male  ☐ Non-binary  ☐ Not Stated  ☐Transgender Female/Male-Female  
☐ Transgender Male/Female-Male	
Address	 <PtStreet>	
Suburb	 <PtCity>	Postcode	 <PtPostcode>	
Phone 1	 <PtPhoneMob>	Phone 2		
Country of Birth		Cultural Identity		
Aboriginal or Torres Strait Islander 	☐ Aboriginal  ☐ Torres Strait Islander    ☐ Both    ☐ Neither   ☐ Unknown	
Main language spoken at home		
Proficiency in spoken English 	☐ Very Well   ☐ Well    ☐ Not Well    ☐ Not at All	
Family/ support person details
Consider involving support person in session if appropriate	
	
ELIGIBILITY FOR EDP	
EATING DISORDER DIAGNOSIS (DSM-V)
https://insideoutinstitute.org.au/resource-library/dsm-5-diagnostic-criteria-for-eating-disorders
	¨  Anorexia Nervosa (AN) (meets criteria for an EDP and additional eligibility criteria not necessary)

must meet all other criteria below

¨  Bulimia Nervosa (BN)                                                          
¨  Binge Eating Disorder (BED)
¨  Other Specified Feeding or Eating Disorder (OSFED)	
EDE-Q Global Score (score ³ 3 for eligibility)  
https://insideoutinstitute.org.au/assessment?started=true		
EATING DISORDER BEHAVIOURS
(at least 1 for EDP eligibility)	¨ Rapid weight loss 
¨ Binge eating (frequency ³ 3 times/ week)
¨ Inappropriate compensatory behaviour (e.g. purging, excessive exercise,           laxative abuse) (frequency: ³ 3 times/week)	
CLINICAL INDICATORS
(at least 2 for EDP eligibility)	¨ Clinically underweight (< 85% expected weight with weight loss due to eating disorder)
Detail:
	
	¨ Current or high risk of medical complications due to eating disorder
Detail:
	
	¨ Serious comorbid psychological or medical conditions impacting function 
Detail any psychological/ medical comorbidities and impact on health/ function:
	
	¨ Hospital admission for eating disorder in past 12 months
	
	¨ Inadequate response to evidence-based eating disorder treatment over past 6 months
Details:
	
EDP ELIGIBILITY CRITERIA MET	¨ YES                               ¨ NO (consider Better Access to mental health plan)	

IINITIAL TREATMENT RECOMMENDATIONS UNDER EDP	
Psychological treatment services (EDPT)  (Initial 10 sessions)	Dietetic services 	
(up to 20 in 12 months)	Psychiatric/paediatric review

Assessment by psychiatrist/ paediatrician required for patient to access EDPT sessions 21-40 	

Referred to:<AdrDetails>

Goals: 

Psychological treatments allowed under EDP 
(to be determined by MH professional):
•	Family based treatment
•	Adolescent focused therapy
•	CBT
•	CBT-AN
•	CBT- BN/BED
•	SSCM for AN
•	MANTRA for AN
•	IPT for BN or BED
•	DBT for BN or BED 
•	Focal psychodynamic therapy for EDs	
Referred to: <AdrDetails>

Goals: 	
Referred to: <AdrDetails>	

Actions record the actions the patient needs to make 

	
Emergency Care/Relapse Prevention  

	
Physical examination conducted (see attached)	¨ YES                               ¨ NO	
Patient education given	¨ YES                               ¨ NO	
Copy of EDP given to patient	¨ YES                               ¨ NO	
Copy of EDP given to other providers	¨ YES                               ¨ NO	
GP REVIEW REQUIREMENTS	
¨ Mental health: Prior or at sessions 10, 20 & 30 of psychological treatment & at EDP completion
¨ Dietetics: after Session 1 or 2 and at EDP completion 

Note: PSYCHIATRIC OR PAEDIATRIC REVIEW 
Required in addition to GP review to access sessions 21-40.  Consider referring early in course of treatment	

MENTAL HEALTH ASSESSMENT & HISTORY	
Previous specialist mental health care		
Family History of Mental Illness		
Social history	
<SocialHx>

Other:
With whom does the person live? 

Highest education level completed: 

What is their employment status? 

Other Relevant Information: 
	
Personal History 	(eg childhood, education, relationship history, coping with previous stressors)

	
Mental Status Examination	

Appearance and General Behaviour
 Normal	   Other: 
	
Mood (Depressed/Labile)
 Normal	   Other: 	

Thinking (Content/Rate/Disturbances)
 Normal	   Other: 	
Affect  (Flat/blunted)
Normal	   Other:

Perception (Hallucinations etc.)
Normal	   Other:	
Sleep  (Initial Insomnia/Early Morning Wakening)
Normal	   Other:

Cognition (Level of Consciousness/Delirium/Intelligence)
	
Appetite  (Disturbed Eating Patterns)

Attention/Concentration
	
Motivation/Energy 

Memory  (Short and Long Term)
	
Judgement  (Ability to make rational decisions)

Insight
	
Anxiety Symptoms  (Physical & Emotional)

Orientation (Time/Place/Person)
	
Speech  (Volume/Rate/Content)

	
Risk Assessment 	
Suicidal ideation             ¨ YES                   ¨ NO	Suicidal intent           ¨ YES                   ¨ NO	
Current plan                    ¨ YES                   ¨ NO	Risk to others.          ¨ YES                   ¨ NO	

RECORD OF PATIENT CONSENT	

I, 	<PtFullName>							,  (patient name - please print clearly)
Agree to information about my mental and medical health to be shared between the GP and the health professionals to whom I am referred, to assist in the management of my health care. 

						<TodaysDate>
Signature (patient):				Date: 				

I (GP) have discussed the proposed referral(s) with the patient and am satisfied that the patient understands the proposed uses and disclosures and has provided their informed consent to these.			

					<UsrName>     <TodaysDate>
GP Signature				GP Name		Date

* Verbal consent documented in patient health record	

EATING DISORDERS PATIENT PHYSICAL ASSESSMENT
	
SUGGESTED INITIAL PHYSICAL ASSESSMENT 	Height, weight, body mass index (BMI; adults), BMI percentile for age (children)

Pulse and blood pressure, with postural measurements

Temperature

Assessment of breathing and breath (eg ketosis)

Examination of periphery for circulation and oedema

Assessment of skin colour (eg anaemia, hypercarotenaemia, cyanosis)

Hydration state (eg moisture of mucosal membranes, tissue turgor)

Examination of head and neck (eg parotid swelling, dental enamel erosion, gingivitis, conjunctival injection)

Examination of skin, hair and nails (eg dry skin, brittle nails, lanugo, dorsal finger callouses [Russell’s sign])

Sit-up or squat test (ie a test of muscle power)
	
USEFUL LABORATORY INVESTIGATIONS	Full blood count

Urea and electrolytes, creatinine

Liver function tests

Blood glucose

Urinalysis

Electrocardiography

Iron studies
B12, folate
Calcium, magnesium, phosphate

Hormonal testing – thyroid function tests, follicle stimulating hormone, luteinising hormone, oestradiol, prolactin

Plain X-rays – useful for identification of bone age in cases of delayed growth
Bone densitometry – relevant after 9–12 months of the disease or of amenorrhoea and as a baseline in adolescents. The recommendation is for two-yearly scans thereafter while the DEXA scans are abnormal.