Remote health atlas forms

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Below is a list of some of the more commonly used forms in Primary Health Care. Additional forms are available via the relevant Atlas Item.

Central Australia Forms

Top End forms

Other Forms

 Electronic Health Record Forms

The following links provide the range of World Health Organisation growth charts endorsed for use in Northern Territory (NT) Department of Health health centres.

Healthy Under 5 Kids (HU5K) Program

 

Boys

Girls

Head circumference-for-age

Birth to 13 weeks

Birth to 13 weeks

Birth to 5 years

Birth to 5 years

Length-for-age

Birth to 6 months

Birth to 6 months

6 months to 2 years

6 months to 2 years

Height-for-age

2 to 5 years

2 to 5 years

Weight-for-age

Birth to 6 months

Birth to 6 months

6 months to 2 years

6 months to 2 years

2 to 5 years

2 to 5 years

Healthy School-Age Kids (HSAK) Program

 

Boys

Girls

BMI-for-age

5-19 years

5-19 years

Height-for-age

5-19 years

5-19 years

Weight-for-age

5-10 years

5-10 years

Supporting Reference Materials

Pharmacy forms are currently available on the information sheets page under the Pharmacy dropdown.

Central Australia Quality Assurance Forms

Accountable Drugs PHC Remote CAHS Form

 these forms are to be completed each month

Cold Chain Storage PHC Remote CAHS Form

Duress Alarm PHC Remote CAHS Form

Essential Checks PHC Remote CAHS Form

Health Centre Monthly Report PHC Remote CAHS Form

Satellite Phones PHC Remote CAHS Form

Stryker® Stretcher PHC Remote CAHS Form

Vehicle Check PHC Remote CAHS Form

Strive for 5 Vaccine Fridge Temperature Chart
Please write the name of health centre and which refrigerator on the chart. 

Personal Protection Equipment Kit PHC Remote CAHS Formcomplete in April
Disaster Pack PHC Remote CAHS Formcomplete in October
Read information sheets on Point of Care Pathology for HemoCue Hb 201+ Quality Control Form
Top End Quality Assurance Forms
Accountable Drugs PHC Remote TEHS Formthese forms are to be completed each month and can be printed via
Quality Return Templates (combined set)
Duress Alarm PHC Remote TEHS Form
Satellite Phones PHC Remote TEHS Form
Stryker® Stretcher PHC Remote TEHS Form
Vaccine Storage PHC Remote TEHS Form
Vehicle Check PHC Remote TEHS Form
Essential Checks PHC Remote TEHS Formcomplete during each month

Strive for 5 Vaccine Fridge Temperature Chart
Please write the name of health centre and which refrigerator on the chart.

complete during each month
Personal Protection Equipment Kit PHC Remote TEHS Formcomplete in April
Disaster Pack PHC Remote TEHS Formcomplete in October
Read information sheets on Point of Care Pathology for HemoCue Hb 201+ Quality Control Form

Last updated: 23 December 2016