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The location of Sudan

https://www.britannica.com/place/Sudan/Cultural-life

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Sudan's history goes back to the pharaonic period. It was the largest and one of the most geographically diverse states in Africa, until its split into two countries in 2011 after southern Sudan voted for independence.

This followed decades of struggle by the mainly Christian and Animist south against rule by the Arab Muslim north.

Modern Sudan has long been beset by conflict and instability since independence, with two lengthy north-south civil wars and a protracted war in the western region of Darfur.

2023 saw fighting break out in the capital, Khartoum, as a result of a vicious power struggle within the country's military leadership.

https://www.bbc.com/news/world-africa-14094995

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Sudanese cuisine is greatly affected by the historical cross-cultural influences of Arab, Nubian, Egyptian, Turkish, and Levantine cuisine in Sudan. Many Sudanese foods have been around for thousands of years. The most common meats eaten are lamb and chicken, in accordance with the Muslim halal laws. Most meals are communal and often shared with family, neighbors, and guests, as part of Sudanese hospitality.

https://www.chefspencil.com/most-popular-foods-in-sudan/

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Plant parts used to prepare traditional medicines

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Plant parts used to prepare traditional medicines

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Sudan folklore medicine is characterized by a unique combination of Islamic, Arabic, and African cultures. In poor communities, traditional medicine has remained as the most reasonable source of treatment of several diseases and microbial infections. Although the traditional medicine is accepted in Sudan, to date there is no updated review available, which focuses on most effective and frequently used Sudanese medicinal plants.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628527/

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For me, the most important aspect was changing the perspective of treating patients who is from diverse backgrounds, I have developed my knowledge refugees are hard to ask for support. Having read theClinical Practice I now think differently when people ask for help but find it hard to express themselves. This skill will be important to me in the workplace to build confidence. Because I am not yet confident with asking about their feeling without offending them, I will now need to build my knowledge. Later, I realised provided them with more information with my knowledge. Equally, this could increase my work satisfaction because I can help more people in my own way.

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The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.

Reference: https://refugeehealthguide.org.au/refugee-patients-in-primary-care/

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When arrive to Australia, health assessment can be different...

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When arrive to Australia, health assessment can be different...

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For the mental health and social and emotional wellbeing component of the assessment:

Consider the family and household composition (i.e. support network and safety in the home)

Assess settlement stressors – ask if the patient has any particular worries getting settled. Consider factors such as support in Australia, housing difficulties, finances and current studies, separation from significant family members, past education and occupation and time spent in immigration detention

Observe appearance, affect and behaviour

Ask about sleep, appetite, energy, mood, anxiety symptoms, memory, concentration and relationships/family functioning

For children/adolescents, in addition to all of the above, ask about behaviour,

https://refugeehealthguide.org.au/refugee-health-assessment/

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FBE - full blood examination, HBsAg - hepatitis B surface antigen, HBsAb - hepatitis B surface antibody, HBcAb - hepatitis B core, MBS - Medical Benefits Schedule, HIV - human immunodeficiency virus, IME - Immigration Medical Examination, TB - tuberculosis, TST - tuberculin skin test, IGRA - interferon gamma release assay, IgG - immunoglobulin G, HbA1c - glycosylated haemoglobin, CVD - cardiovascular disease, Ca - calcium, POFBE - full blood examination, Hb - haemoglobin, Ca - calcium, PO

Written by on . Posted in Approach to patient care

Overview
Offer a comprehensive post-arrival health assessment to every child, adolescent and adult from a refugee background who is new to your care, preferably within one month of arrival. Always use person-centred care principles that consider the impact of past trauma. Use language and gender appropriate interpreters. See Approach to consultation and management, Communication and interpreters.
Key points
A refugee health assessment includes: migration history; a full medical history, including current concerns, developmental history in children and adolescents and psychosocial history; physical examination; investigations; and development of a management plan. For children and adolescents, history may be taken from a parent or carer where appropriate. In some states and territories, post-arrival health assessments are provided by a specialised refugee health service. In primary care, refugee health assessments can be supported by refugee health nurses or practice nurses. Refugee health nurses provide specialised support and assistance for primary care clinicians and people from refugee backgrounds. For the contact details of your local refugee health nurse or refugee health service, see State and territory referrals.
Practice tip: The 'Health assessment for refugees and other humanitarian entrants' is funded up to 1 year post arrival or visa grant date through the Medicare Benefits Schedule (MBS) (Items 701, 703, 705 and 707). The assessment can be completed over a number of consults. For eligible visas see 'Health assessment for refugees and other humanitarian entrants'.Practice tip: The Refugee Health Assessment template can be used to assist GPs and nurses to undertake a health assessment.

Approach to refugee health assessment
When offering a health assessment, ensure the patient - including a parent/caregiver for children and adolescents - understands that the assessment is voluntary, and give clear explanations about the process. Be aware that screening for asymptomatic illness and disease prevention may be unfamiliar concepts for some people from refugee backgrounds. Take a gradual approach to post-arrival health assessment, aiming to build rapport. Start with the patient's current concerns. This is to determine if active disease is present and to develop a trusting relationship. This discussion can also help you determine the patient's level of health literacy. Next, take a detailed medical and psychosocial history, and then perform a physical examination. The complete assessment should be conducted over several appointments. Potentially sensitive issues such as sexual health and mental health screening can be addressed after rapport has been established.
Practice tip: Explain that the health assessment and investigations are simply to ensure good health and will have no negative consequences for visa status.Practice tip: Free translation of personal documents including medical documents and qualifications is available. The Free Translating Service provides translation into English of medical reports or vaccination certificates (in the form of an extract or summary) within the first 2 years of a patient's eligible visa grant date. More information.
The following section is derived from Recommendations for comprehensive post-arrival health assessment for people of refugee-like backgrounds(ASID/RHeaNA Recommendations) for use in primary care.
History

Migration history

Country of birth, countries of transit and any time in detention centres

Current visa status

Medical history

Practice tip: Consider requesting a fee waiver for the transfer of previous health records from another practice.

Current health concerns

Past medical history, family history, medications, allergies

Determine which screening tests and vaccinations have been completed pre-migration and since arrival in Australia. For information about access to pre-departure health information through HAPlite. Note: the Immigration Medical Examination (IME) is more limited in children. See Children, Adolescents.

History of or contact with:

tuberculosis (TB), malaria, parasistic infections

hepatitis B Virus (HBV), hepatitis C Virus (HCV), human immunodeficiency virus (HIV)

sexually transmitted infections (STIs)

respiratory symptoms, gastrointestinal symptoms, systemic/localising symptoms

Immunisation history including:

written documentation pre and post arrival

Bacille Calmette Guerin (BCG) scar

natural infection such as HBV and varicella

previous vaccine reactions

Chronic non-communicable diseases and issues such as:

cardiovascular disease (CVD), diabetes, chronic obstructive pulmonary disease (COPD), thyroid

injuries, accidents and hospitalisations

hearing, vision and dental problems

other disabilities and adaptive function problems

Lifestyle/risk factors including:

Smoking, alcohol intake, substance use (including substances common in certain areas e.g. betel nut, sheesha, khat)

Risk factors for low vitamin D

Nutrition (food access, current nutritional status)

Additional considerations for specific patient groups and health concerns: Child/adolescent health - the assessment should include all of the above (as appropriate) as well as growth, development, education history, perinatal and postnatal history. See , Adolescents. Women's healt h - the assessment should include all of the above, past and current pregnancies/births, contraception, breastfeeding, cervical and breast screening, female circumcision/traditional cutting, intimate partner violence Sexual health (men, women and adolescents) - risk factors for acquiring an STI; contraception
Practice tip: Individuals may not want to disclose their sexual history, but should still be offered STI screening confidentially and sensitively. Some concepts may need to be explained, such as sexual intercourse, sexual contact, sexually transmitted infections and risk i.e. unprotected sex. Be aware and sensitive to a history of sexual violence/abuse at all ages and genders. A useful approach may be: 'People can get infections from having sex. Would you like testing for these infections?' 'Sometimes people are forced to have sex. You do not have to tell me details, but if this has happened I think you should have testing. There is lots of help available when you are ready' 'Anything we talk about is confidential and I cannot tell anyone, except if you or someone else might be at risk of serious harm. Interpreters are never allowed to tell anyone about consultations.' Would you like to know more about your risk? Do you have any other questions about your sexual health?' For more information about discussing sexual health and STIs with people from refugee backgrounds seeSexually Transmissible Infections.

Psychosocial history
For the mental health and social and emotional wellbeing component of the assessment:

Consider the family and household composition (i.e. support network and safety in the home)

Assess settlement stressors - ask if the patient has any particular worries getting settled. Consider factors such as supports in Australia, housing difficulties, finances and current studies, separation from significant family members, past education and occupation and time spent in immigration detention

Observe appearance, affect and behaviour

Ask about sleep, appetite, energy, mood, anxiety symptoms, memory, concentration and relationships/family functioning

For children/adolescents, in addition to all of the above, ask about behaviour, schooling, nightmares and enuresis (bed wetting).

It is generally not advisable to ask directly about a person's experience of torture or other traumatic events. However, the potential impacts on psychological health should be assessed.
Practice tip: A useful form of questioning might be: Terrible things have often happened to people who have been forced to leave their countries. I do not need to know the details about what you have been through, but have you had any experiences that might be affecting your health or how you are feeling now?

When mental health concerns are evident, consider further mental health assessment including suicide risk assessment

Continue to monitor for psychosocial problems as the presentation of these can often be delayed

Consider recall for rescreening after 6-12 months for those who visit your service less frequently

See Approach to consultation and management, Psychological effects of torture or other traumatic events.
Physical examination

Skin conditions, including hair and nails, BCG scar

Fever - exclude malaria

Ear, nose and throat (ENT) and dental examination - look particularly for middle ear disease and dental caries

Blood pressure (BP)

Body mass index (BMI), nutritional status - weight, height, waist/hip ratio* (adults), head circumference (children)

Pallor/murmur as a sign of anaemia - consider causes such as iron, B12 and folate deficiencies and lead toxicity among other causes

Signs of other micronutrient deficiencies - e.g. dry eyes (vitamin A), skin (zinc, vitamin C, other), gums (vitamin C), lips/tongue (B-group vitamins, including B12), hair/nails (zinc, other), goitre (iodine), teeth/rickets (vitamin D)

Cervical, axillary and inguinal lymphadenopathy - consider TB and HIV

Cardiorespiratory exam - consider TB, COPD, murmurs, CVD

Hepatosplenomegaly - consider chronic malaria, chronic liver disease including HBV, schistosomiasis, TB, HIV

Evidence of torture or other injuries

Neurology - consider gait, tone, power, reflexes and coordination

Visual acuity - all ages. For African people >40 years and others >50 years, refer to optometry for a glaucoma check

*Note there may be different normal values for different ethnic groups
Investigations
Screening investigations for conditions of high prevalence should be offered to all new patients according to their individualised risk as recommended by ASID & RHeaNA 1,2 and the RACGP 3 (see Table 1^) if not previously completed. Make sure that you have informed consent for all investigations and that you offer STI screening confidentially. ⁴ The ASID/RHeaNA recommendations for commencing risk assessment of diabetes and CVD are earlier than those given by the RACGP in the Guidelines for preventative activities in general practice, ³ and so have been included in Table 1. Complete all other recommended screenings as per the RACGP Guidelines. See Table 4 for further screening and management links. Additional investigations are determined by presenting symptoms.
Table 1: Recommended initial screening investigations for people from refugee backgrounds ¹⁻³

Hepatitis B Serology (HBsAg, HBsAb, HBcAb)

Write 'Query chronic hepatitis B?' on the pathology request slip to meet MBS requirements

Hepatitis C Ab, and HCV RNA if HCV Ab positive

Strongyloides stercoralis serology

Latent TB screening with TST (Mantoux test) or IGRA (e.g. Quantiferon Gold)

Offer test with intention to treat ≤35 years; if >35 years testing depends on risk factors and local jurisdiction. Check Medicare for IGRA rebates, TST preferred in children <5 years

Age-based/risk-based

Varicella serology

≥14 years old if no known history of disease

Rubella IgG

Women of child-bearing age

Fasting glucose and or HbA1c**

Consider risk in patients ≥35 years if high-risk ethnicity (Asian, Middle Eastern, Pacific Islander, Southern European, North or Sub-Saharan African) and/or overweight and other risk factors
Use Diabetes Risk Assessment Tool

Fasting lipids**

Consider risk in patients ≥35 years from CVD high-prevalence countries (South-East Asia and Southern Europe) and/or with risk factors such as obesity, hypertension or other risk factors
Use CVD Risk Calculator

Ferritin

All women and children; men who have risk factors

Vitamin D, also check Ca, PO4 and ALP in children

Risk factors such as dark skin, lack of sun exposure
Write risk factors on pathology request

Vitamin B12

Arrival <6 months; food insecurity; vegan; from Bhutan, Afghanistan, Iran, Horn of Africa

Syphilis serology

Risk of STIs, unaccompanied or separated minor

First-pass urine or self-obtained vaginal swabs for gonorrhoea and chlamydia PCR

Risk factors for STIs, or on request*

Helicobacter pylori stool antigen or breath test

Upper gastrointestinal symptoms or family history of gastric cancer

Country-based

Residence in and/or travel through endemic areas
See ASID/RHeaNA country-specific screening recommendations

Malaria thick and thin films and malaria RDT
Travel from/through an endemic malaria area within 3 months of arrival if asymptomatic, or within 12 months if symptoms of fever
See ASID/RHeaNA country-specific screening recommendations

*ASID/RHeaNA panel did not reach consensus on these recommendations. **Do not delay pathology if fasting tests are difficult to organise. ₄ - phosphate, ALP - alkaline phosphatase, STI - sexually transmitted infections, PCR - polymerase chain reaction, OCP - ova, cysts, parasites, RDT - rapid diagnostic testing, Ab - antibody, HCV - hepatitis C virus, RNA - ribonucleic acid ^Table 1 does not appear in this format in the ASID/RHeaNA Recommendations. Table 1 has been oriented towards the primary care setting and relies heavily on the ASID/RHeaNA Recommendations. Practitioners should check with their local refugee health or infectious disease services if they have concerns about which tests to include. See State and territory referrals.
Practice tip: Add recommended investigations, according to the countries of origin/transit commonly seen in your practice and other risks, to your pathology favourites in your computer software list. A summary table of country-based risk can also be printed. See ASID/RHeaNA country specific recommendations for malaria, schistosomiasis and hepatitis C screening.Practice tip: Under Medicare, there is an upper limit on the number of pathology services payable in a single episode requested by a GP. This is referred to as coning. If more than three items are requested, MBS will only pay for the three most expensive items. This may impact on the ability of some GPs to undertake post-arrival refugee screening. It is recommended individual GPs discuss this issue with their local pathology provider.

Management plan and referral

Ensure all investigation results are discussed and their significance explained.

Practice tip: Provide opportunities for the patient to ask questions or seek clarification about results and management. Some patients will have come from cultures where this is not encouraged.

After review of the history, examination and investigations, formulate a problem list. This may include:

Clinical findings e.g. diagnoses, undiagnosed symptoms, positive test results

Catch-up immunisation (all patients should be offered catch-up vaccines to the equivalent Australian age)

Psychological and/or developmental concerns

Settlement concerns

Preventative health - complete screening as per RACGP Guidelines (see Table 4). Note that some investigations may be unfamiliar to people from refugee backgrounds and therefore require additional time for informed consent. Chronic disease risk factor management should be considered

Provide a management plan for each problem, including referrals if required

Practice tip: Provide education about eHealth record. As people frequently move in the early settlement period, offer a patient-held record of the completed health assessment and vaccinations.Practice tip: Commence immunisation catch-up and register all vaccines (including offshore vaccines) on the Australian Immunisation Register (AIR) as soon as possible to avoid Centrelink implications (reduced family benefit payments). Once the first set of catch-up vaccines are on AIR, payments will be optimised and remain at this rate if catch-up is continued and completed.

Table 2: Management of infectious conditions 1,2

Eosinophilia

FBE*

Eosinophilia >0.6 x 10 ⁹/L or above reference range

Investigate and treat causes of eosinophilia, including intestinal parasites, Strongyloides, schistosomiasis

Hepatitis B

HBsAg, HBsAb, HBcAb

HBsAg positive**

Arrange clinical assessment, blood tests and abdominal ultrasound
Vaccinate non-immune household contacts and sexual partnersTest for and vaccinate against hepatitis A
See ASID/RHeaNA Immunisation

Strongyloidiasis

Strongyloides stercoralis serology

Strongyloides serology positive or equivocal

Stool microscopy for OCP
Check for eosinophilia
Treat with ivermectin 200 mcg/kg (≥15 kg) on day 1 and 14
Refer pregnant women or children <15 kg to specialist
Follow up serology at 6 and 12 months

Latent tuberculosis infection

Exclude active TB infection** - if suspicion of active infection refer to TB services Ensure appropriate infection control precautions

Exclude active TB infection** - if suspicion of active infection refer to TB servicesEnsure appropriate infection control precautions

Exclude active TB infection** - if suspicion of active infection refer to TB servicesEnsure appropriate infection control precautions

TST or IGRA

Positive TST or IGRA

Refer to TB services for CXR and consideration of LTBI preventative therapy with isoniazid 10 mg/kg (up to 300 mg) daily for 6-9 months
See ASID/RHeaNA Tuberculosis (TB and LTBI)

HIV

HIV serology

HIV serology positive**

Refer to local HIV care provider

STI

First pass urine or self-obtained vaginal swabs for gonorrhoea and chlamydia PCR
Syphilis serology

Regardless of test result

Offer women a pregnancy test and contraception as appropriate
See ASID/RHeaNA Women's Health

Chlamydia positive**

Treat with azithromycin 1 g orally as a single dose OR doxycycline 100 mg orally 12 hourly for 7 days
Treat anorectal chlamydia with doxycycline 100 mg orally 12 hourly for 7 days or azithromycin 1 g orally as a single dose with a repeat dose a week later

Gonorrhoea positive**

Take samples for gonorrhoea culture before treatment
Ceftriaxone 500 mg in 2 mL of 1% lignocaine IMI
PLUS azithromycin 1 g orally
Repeat NAAT and culture for test of cure for gonorrhoea 2 weeks after treatment

Syphilis positive**

Parenteral penicillin (if not previously treated) in the context of a sexual health or ID unit

Helicobacter pylori

H pylori stool Ag or breath test

Ag or stool test positive

Treat as per TG (gastrointestinal)⁵
Follow up with repeat test at least 4 weeks after treatment
If first-line therapy is unsuccessful, refer to specialist for second-line medication
Refer to specialist for consideration for endoscopy irrespective of H pylori status if 'red flags' are present (e.g. anorexia, weight loss, dysphagia, gastrointestinal bleeding or abdominal mass) or if symptoms of dyspepsia and age >50 years

Intestinal parasites

Check for eosinophilia
If documented pre-departure albendazole therapy
* No eosinophilia and no symptoms - no investigation or treatment required
* Eosinophilia - perform stool microscopy for OCP followed by directed treatment
If no documented pre-departure albendazole therapy, depending on local resources and practices, there are two acceptable options:
1. Empiric single-dose albendazole therapy (200 mg if age >6 months and weight 6 months and weight <10 kg; 400 mg if ≥10 kg) for 3 days, except for Ascaris lumbricoides, which only requires 400 mg as a single dose (200 mg in children >6 months and <10 kg). Mebendazole is an option for some parasites
Treat Giardia lamblia with tinidazole 2 g as a single dose (50 mg/kg children, maximum 2 g) or metronidazole 2 g daily for 3 days (30 mg/kg/dose children, maximum 2 g)

Check for eosinophilia If documented pre-departure albendazole therapy* No eosinophilia and no symptoms - no investigation or treatment required* Eosinophilia - perform stool microscopy for OCP followed by directed treatment If no documented pre-departure albendazole therapy, depending on local resources and practices, there are two acceptable options:1. Empiric single-dose albendazole therapy (200 mg if age >6 months and weight 6 months and weight <10 kg; 400 mg if ≥10 kg) for 3 days, except for Ascaris lumbricoides, which only requires 400 mg as a single dose (200 mg in children >6 months and <10 kg)Mebendazole is an option for some parasitesTreat Giardia lamblia with tinidazole 2 g as a single dose (50 mg/kg children, maximum 2 g) or metronidazole 2 g daily for 3 days (30 mg/kg/dose children, maximum 2 g)

Check for eosinophilia If documented pre-departure albendazole therapy* No eosinophilia and no symptoms - no investigation or treatment required* Eosinophilia - perform stool microscopy for OCP followed by directed treatment If no documented pre-departure albendazole therapy, depending on local resources and practices, there are two acceptable options:1. Empiric single-dose albendazole therapy (200 mg if age >6 months and weight 6 months and weight <10 kg; 400 mg if ≥10 kg) for 3 days, except for Ascaris lumbricoides, which only requires 400 mg as a single dose (200 mg in children >6 months and <10 kg)Mebendazole is an option for some parasitesTreat Giardia lamblia with tinidazole 2 g as a single dose (50 mg/kg children, maximum 2 g) or metronidazole 2 g daily for 3 days (30 mg/kg/dose children, maximum 2 g)

Schistosomiasis

Schistosoma serology

Schistosomiasis serology positive or equivocal

Treat with praziquantel (40 mg/kg orally, taken in one dose or divided into two doses taken 4 hours apart; no upper dose limit)
As serology does not determine parasite burden or end-organ disease, perform microscopy (urine and stool) for ova and urine dipstick for haematuria
If positive dipstick, perform end-urine microscopy for ova (ideally collected between 10 a.m. and 2 p.m.)
If positive for ova on urine or stool, evaluate further for end-organ disease with ultrasound and LFTs
Seek advice from a paediatric specialist for treatment of children <5 years

Malaria

Malaria thick and thin films and RDT

Positive test**

Unwell patients and those with P falciparum malaria should be admitted to hospital urgently
Treat in consultation with ID specialist
Children, pregnant women and people with low immunity are at particular risk

Hepatitis C

Hepatitis C Ab

Anti-Hepatitis C Ab positive**

HCV RNA test - if positive, refer to a doctor accredited to treat HCV for further assessment
Test for and vaccinate against hepatitis A
See ASID/RHeaNA Immunisation

*FBE is also performed as an investigation for anaemia. This is listed in Table 3. **Notifiable disease. FBE - full blood examination, HBsAg - hepatitis B surface antigen, HBsAb - hepatitis B surface antibody, HBcAb - hepatitis B core, TB - tuberculosis, TST - tuberculin skin test, IGRA - interferon gamma release assay, CXR - chest X-ray, LTBI - latent tuberculous infection, HIV - human immunodeficiency virus, PCR - polymerase chain reaction, IMI - intramuscular injection, NAAT - nucleic acid amplification test, ID - infectious disease, Ag - antigen, TG - Therapeutic Guidelines, LFTs - liver function tests, RDT - rapid diagnostic test, HCV - hepatitis C, RNA - ribonucleic acid
Table 3: Management of non-infectious conditions1,2

Condition

Diagnostic test

Result

Initial management

Anaemia

FBE

Low Hb (age and sex dependent)

Investigate and treat causes of anaemia

Iron deficiency

Ferritin

Ferritin <15 µg/L in adults
Check reference ranges for children

Investigate and treat causes
Treat with iron supplementation if iron <15 µg/L (or below reference range for children) and/or when clinical and haematological features indicate iron deficiency anaemia
Educate about iron-rich diet and avoid excessive dairy intake in children

Low vitamin D

25-hydroxy vitamin DAlso Ca, PO ₄ and ALP in children

Vitamin D level <50 nmol/L

Treat to restore levels to the normal range with either daily dosing or high-dose therapy, ensuring adequate calcium intake and paired with advice about sun exposure and self-management
See ASID/RHeaNA Low Vitamin D

Vitamin B12 deficiency

Serum active vitamin B12 (holotranscobalamin)

Serum active B12 if <35 pmol/L or below reference range in children

Treat if <35 pmol/L or below reference range for children with oral or IM supplementation
Exclude concomitant folate deficiency
Consider Helicobacter pylori infection

Table 4: Useful links for further screening and management
IgG - immunoglobulin G, ASID/RHeaNA - Australian Society for Infectious Diseases/Refugee Health Network of Australia, RACGP - Royal Australian College of General Practitioners, FGM/C - female genital mutilation/cutting, CVD - cardiovascular disease, COPD - chronic obstructive pulmonary disease, CKD - chronic kidney disease, ENT - ear, nose and throat, NDIS - National Disability Insurance Scheme, MCH - Maternal and Child Health
Considerations
₄ - phosphate, ALP - alkaline phosphatase, IM - intramuscular
Consider other Medicare item numbers when planning further appointments with patients, e.g. care plans, case conferences, and mental health items

Resources

References

1. Chaves NJ, Paxton G, Biggs BA, Thambiran A, Smith M, Williams J, Gardiner J, Davis JS. Recommendations for comprehensive post-arrival health assessment for people from refugee-like backgrounds: Australasian Society for Infectious Diseases and Refugee Health Network of Australia; 2016.

2. Chaves NJ, Paxton GA, Biggs BA, et al. The Australasian Society for Infectious Diseases and Refugee Health Network of Australia recommendations for health assessment for people from refugee-like backgrounds: an abridged outline. The Medical Journal of Australia. 2017;206(7):310-315.

3. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9 ed. East Melbourne: RACGP; 2016.

4. Australasian Sexual Health Alliance. Australian STI Management Guidelines for use in primary care. 2016; www.stiguidelines.org.au.

5. Gastrointestinal Expert Group. Gastrointestinal. Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited; 2016.

# data[].attributes.attachment_link.description
FBE - full blood examination, HBsAg - hepatitis B surface antigen, HBsAb - hepatitis B surface antibody, HBcAb - hepatitis B core, MBS - Medical Benefits Schedule, HIV - human immunodeficiency virus, IME - Immigration Medical Examination, TB - tuberculosis, TST - tuberculin skin test, IGRA - interferon gamma release assay, IgG - immunoglobulin G, HbA1c - glycosylated haemoglobin, CVD - cardiovascular disease, Ca - calcium, POFBE - full blood examination, Hb - haemoglobin, Ca - calcium, PO Written by on .