[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-177832-105":53,"doc-detail-177832-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","about-me-patient-profile","About Me - Patient Profile","","Health clinic patient profile template for documenting personal information, communication preferences, support needs, cultural and spiritual needs, disabilities, and key health information. Includes consent sections for the clinic to keep the profile on file, share it with other health professionals, and optionally add records to My Health Record. Captures decision-making/legal medical treatment authority, supporter details, appointment assistance requests, and guidance for how clinicians should communicate.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/about-me-patient-profile/177832/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/about-me-patient-profile/177832.png","ImageObject",442,249,{"name":88,"@type":89},"Aria Callaghan","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-10-23","2026-09-02",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information does the patient profile collect?","Question",{"text":109,"@type":110},"It collects patient identity and contact details, pronouns, date of birth, main language at home, support needs for communication, cultural/spiritual needs, disabilities, and key health information.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How does the form handle consent and sharing of information?",{"text":114,"@type":110},"It includes consent for the clinic to keep the profile on file and separate consent for sharing with other health professionals, including details of who provided consent and the consent date.",{"name":116,"@type":107,"acceptedAnswer":117},"What communication and appointment support preferences can be recorded?",{"text":118,"@type":110},"The form records how the patient communicates, preferred ways clinicians should communicate (e.g., slow speech, easy words, pictures/videos, take-home materials), and appointment needs such as reminder preferences and longer appointment time.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},177832,1790238337,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":73},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","You can add a photo here\nAbout Me - Patient Profile\nThis About Me – Patient Profile is recommended for you to share with your health clinic. This can be shared with all the clinical team so they know how to best connect with you on each visit by understanding your communication and support needs.\nIt is recommended that this Patient Profile is reviewed yearly to make any changes or updated as changes occur.\nMy patient information\nMy name:\nPlease tick – My pronouns:   \u0003☐\u0004 She / her     \u0003☐\u0004 He / him     \u0003☐\u0004 They / them     \u0003☐\u0004 Other\nDate of birth (dd/mm/yyyy):\nAddress:\nPhone number:\nPlease tick – My main language spoken at home is:\nDo you need another person to assist you to communicate? \u0003☐\u0004 Yes     \u0003☐\u0004 No\n\u0003☐\u0004 Key worker   \u0003☐\u0004 House supervisor \u0003☐\u0004 Interpreter     \u0003☐\u0004 other (e.g. parent, sibling)\nPlease tick – I identify as Aboriginal and or Torres Strait Islander:   \u0003☐\u0004 Yes     \u0003☐\u0004 No\nPlease share – My cultural and spiritual needs are:\nPlease share – My primary disability is:\nPlease share – My other disabilities are (if required):\nOther information you may wish to share:\nPlease share – My key health information is:\nMy consent\nI, (patient name) _____________________________ provide my consent for this About Me – Patient Profile to be kept on file at (name of clinic):\nNote: You may have a key person or supporter in your life who knows you best. This may be a key worker, house supervisor or other (advocate, parent, sibling etc). Please provide their name and details so we can talk directly to them, and they can give us information on your behalf.\nName (supporter name):\nTheir relationship to me is:\nTheir phone number:\nThis form was completed on (date) (dd/mm/yyyy):\nName (supporter name):\nTheir relationship to me is:\nTheir phone number:\nThis form was completed on (date) (dd/mm/yyyy):\nDecision-making\nNote: A ‘medical treatment decision maker’ is someone who has legal authority to make medical treatment decisions for you under the Victoria’s Medical Treatment Planning and Decisions Act 2016.\nPlease tick – I have a legal Medical Treatment and Decision Maker:   \u0003☐\u0004 Yes     \u0003☐\u0004 No \u000bIf yes, their name is:\u000bTheir relationship to me is: \u000bTheir phone number is:\nHow I communicate\nFor example, I use a communication device. I can take 30 seconds to think and answer questions.\nPlease share – The way I communicate is:\nOptional: Record a short video and add the link here:\nWeblink for video:\nHow you should communicate to me\nPlease tick and share – I need health professionals to communicate with me by:\n\u0003☐\u0004 Talk slowly and use easy words.\n\u0003☐\u0004 Use pictures and videos to explain things, so I can look at them again later.\n\u0003☐\u0004 Give me information to take home (preferred format below). \u000b          (\u0003☐\u0004 Text written on paper)   (\u0003☐\u0004 Email)   (\u0003☐\u0004 Audio)   (\u0003☐\u0004 Video)\nMore information:\nMy appointment needs\nHealth professionals: Make sure you check what is the role of the support person.\nPlease tick and share – For my appointments I need:\n\u0003☐\u0004 A phone call reminder for my upcoming appointment.\n\u0003☐\u0004 An SMS reminder to my primary support person about my appointment.\n\u0003☐\u0004 A longer time for my appointments to support my communication needs.\nMore information:\n3 things to connect with me\nFor example, I have a dog named Larry. I like gardening. Please ask about my day.\n3 things I do not like when I see a health professional\nFor example, I do not like sitting in the waiting room – please let me wait in the car.\nMy Health Record\nPlease tick – I would like my health information added to My Health Record:\u000b   \u0003☐\u0004 Yes     \u0003☐\u0004 No\nConsent to share this information\nPlease tick – I consent for this “About Me – Patient Profile” to be shared with other health professionals, inclusive of but not limited to when making a referral:\u000b   \u0003☐\u0004 Yes     \u0003☐\u0004 No    \u000bWho provided consent:\nDate (dd/mm/yyyy):\nHealth professionals: If it has been more than 12 months it is preferable to re-confirm consent.\n\u000f\nMy treating health professionals\nMy GP clinic:\nMy doctor or GP:\nClinic phone number:\nNote: Th","cbCaiviIBHEGEGum","https://ap.wps.com/l/cbCaiviIBHEGEGum","docx",104266,6,"English","# My patient information\n## My consent\n## Decision-making\n## How I communicate\n## How you should communicate to me\n## My appointment needs\n## 3 things to connect with me\n## 3 things I do not like when I see a health professional\n## My Health Record\n## Consent to share this information\n## My treating health professionals","[{\"question\":\"What information does the patient profile collect?\",\"answer\":\"It collects patient identity and contact details, pronouns, date of birth, main language at home, support needs for communication, cultural/spiritual needs, disabilities, and key health information.\"},{\"question\":\"How does the form handle consent and sharing of information?\",\"answer\":\"It includes consent for the clinic to keep the profile on file and separate consent for sharing with other health professionals, including details of who provided consent and the consent date.\"},{\"question\":\"What communication and appointment support preferences can be recorded?\",\"answer\":\"The form records how the patient communicates, preferred ways clinicians should communicate (e.g., slow speech, easy words, pictures/videos, take-home materials), and appointment needs such as reminder preferences and longer appointment time.\"}]","About Me - Patient Profile | DOCX",1788329336]