EA-4.04 · Health & Wellbeing Record

1. Start

Person's name

Preferred name

Service / provider

Lead person / key contact

Date created

Next review date

What health areas need a record?

Choose all that apply. Only the relevant sections will open.

Medication support belongs in EA-4.03. Risk controls belong in EA-4.01. This record should link to them rather than repeat the same detail.

2. Person's Health & Wellbeing

How does the person describe their health?

What helps the person feel well?

What health support does the person want?

How does the person communicate pain, illness or discomfort?

What helps the person understand health information?

Who does the person want involved in health decisions?

3. Long-Term Health Conditions

Condition	How it affects the person	Support needed	Professional / plan

What changes should lead to a review or professional contact?

4. Allergies & Sensitivities

Allergen / sensitivity	Typical reaction	What to do

Emergency advice / plan location

5. Eating, Drinking & Nutrition

What can the person manage independently?

What support is needed?

Any food, drink, texture or swallowing needs?

Any professional guidance to follow?

What changes should people look for?

When should professional advice be sought?

6. Mobility & Physical Support

How does the person usually move around?

What can the person do independently?

What support, equipment or aids are used?

Any falls history or changes in mobility?

What should trigger a risk review or professional referral?

If a fall or mobility issue creates an ongoing safety risk, update EA-4.01 as well.

7. Pain

How does the person show or describe pain?

What usually helps?

What changes in pain should cause concern?

When should professional advice be sought?

8. Sleep

What is the person's usual sleep pattern?

What helps the person sleep well?

What changes or concerns should be recorded?

When should health advice be sought?

9. Emotional & Mental Wellbeing

What helps the person feel calm, safe and well?

What may affect their wellbeing?

What early signs may show that the person is struggling?

What support usually helps?

When should professional or urgent help be sought?

If there is a safety risk linked to distress, self-harm, behaviour or vulnerability, update EA-4.01 as well.

10. Sensory Needs

What sensory needs affect health or wellbeing?

What environments or experiences may cause distress or discomfort?

What adjustments help?

What should people avoid?

11. Health Monitoring

Only monitor something where there is a clear reason and an agreed response to the result.

What is monitored?	How often?	Normal / expected range or baseline	When to act

Where are detailed readings recorded?

12. Health Professionals & Appointments

Person / service	Role	Contact	Why involved

What support does the person need before, during or after appointments?

Where are appointment outcomes / professional instructions recorded?

13. When Health Changes

Do not rely on this form in an emergency. Follow current emergency, clinical and service procedures.

What signs may show the person is becoming unwell?

What should be done first?

When should GP, NHS 24, pharmacist or another professional be contacted?

When should emergency services be contacted?

Who else should be informed where appropriate?

What key information should go with the person if they attend hospital or urgent care?

14. Agreed Health & Wellbeing Plan

Key health information everyone supporting the person should know

What support should be provided?

What should trigger an early review?

Actions

Action	Who?	Due date	Done

Linked records

EA-1.01 Rights, Consent & Legal Authority Record

EA-4.01 Risk, Safety & Emergency Plan

EA-4.02 Accident, Incident, Near-Miss & Safeguarding Report

EA-4.03 Medication Management Record

EA-4.06 PEEP

EA-6.01 Person-Centred Support Plan

EA-6.02 Support Review & Outcomes Record

15. Agreement & Sign-Off

Person's comments

Person's name

Date

Person's signature

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Reviewer / lead person's name

Role

Date

Reviewer signature

Upload signature

If the person did not sign, explain why and how their views were recorded