<TodaysDate> 
PELVIC PAIN and/or ENDOMETRIOSIS PLAN
(May act as a GP MANAGEMENT PLAN & TEAM CARE ARRANGEMENT- MBS items 721 & 723)

Patient name (Medicare): <PtFullName>	Preferred name: <PtPrefName> 	 Gender identity and pronouns: <GenderIdentity>  	
DOB: <PtDoB> 	Address: <PtStreet> <PtCity> <PtPostcode>	Phone: <PtPhoneMob>	
General practitioner details: <DrDetails>	Medicare details: <PtMCNo> <PtMCLine>	Carer details (if relevant):	
Eligible for GPMP/TCA due to pelvic pain or endo present >6/12- YES
Previous care plan (date, outcome)-	
Relevant medical history:  <SelectedPMH>	
Baseline Observations-	
BP (sitting):                                                	Pulse: 		
Height:	Weight:	BMI:  	
Baseline diagnostic tests and questionnaires-	
STI screen- HVS Chlamydia/Gonorrhoea/Trich PCR and MCS	Urine Analysis & Pregnancy Test-	
Transvaginal Ultrasound (in last 12 months)-	Results of Questionnaires- PPFA; DASS21; 3PSQ, any others	

General Health Goals	

Care component	Goals/changes 	Required actions and services	Review progress on goals	
Physical activity	•	Aim- physical activity daily
•	Tailor types of activity throughout cycle if required	Patient:
•	Trial different forms of exercise eg- walking, yoga, swimming, Tai Chi and note what works best for you, and what exacerbates pain.
•	Attend relevant group sessions in 2024
HCP:
•	Refer to exercise physiologist if wanted
•	Discuss different options
•	Advise of relevant group session information when available	•	Review plan/goals
•	+/- exercise physiologist referral if not already done
•	Provide any further resources	
Diet	•	Maintain healthy eating
•	Include foods that help to minimise inflammation, optimise microbiome and support hormonal pathways
•	Reduce caffeine, alcohol, soft drinks	Patient:
•	Keep food diary and assess if particular foods affect your symptoms
•	Look at resources sent and apps that may provide info
•	Consider dietitian review- particularly if gut or IBS symptoms
•	Monitor trigger foods
HCP:
•	Advice regarding anti-inflammatory, FODMAP and endo diets from resource list
•	Provide relevant resources	•	Review plan/goals
•	+/- dietitian referral if not already done
•	Provide any further resources	
Lifestyle and self-care	•	Prioritise time for self-care and relaxation
•	Avoid smoking, excessive alcohol use, drug use	Patient:
•	Schedule in self-care time as able
•	identify activities that can still be enjoyed with pain flares
•	Look at and complete "3 small things" worksheet to bring to 2nd nurse appt
HCP:
•	Discuss any substance use or mental health concerns as needed
•	Psychologist information sheet and other resources provided	•	Review plan/goals
•	Referrals if appropriate
•	Provide any further resources	
Health screening
	•	Keep up to date with routine health screening for age	Cervical screen - 
Mammogram - 
Bowel screening - 
Bone Mineral Density - 
Patient:
•	Attend regular screening
HCP:
•	Follow up any abnormal results		
Sleep	•	Aim for regular, restful sleep (7-9 hours)	Patient:
•	Sleep hygiene - regular night routine, limit screen time before bed
•	Aim for same wake up time each day
•	See resources 
HCP:
•	Provide any relevant resources
•	Discuss and give any relevant advice at appointments
•	Discuss any concerns with GP
	•	Review plan/goals
•	Provide any further resources 	
Pelvic pain specific goals	
Care component	Goals/changes	Required actions and services	Review progress on goals	
Education	•	Ongoing education regarding pelvic pain
•	Engage in Pelvic Pain and Endometriosis Clinic	Patient:
•	Utilise resources package
•	Book and attend next appointment (with pelvic physio) 
•	Attend group sessions in 2024
HCP:
•	Resources discussed and given/sent after appt
•	Give group session info when available
•	1:1 education with physio 	•	Review learning from resources, answer questions, provide further information
•	Review engagement, attendance, clarify any cancelled/no-show appointments if needed	
Symptom management
•	Non-pharmacological	•	Optimise pain management and physical function including during pain flares
•	Patient's specific goals eg- improve sexual activity enjoyment, decrease pain with toileting
•	Understand different types of pain, pain pathways and the role of the brain in interpreting pain
	Paient:
•	Look at resource package and utilise as discussed
•	Trial various options: heat pack, TENS machine, massage, acupuncture; monitor effect on symptoms and pain
•	TENS machine hire ($125 upfront, two week hire, $100 refund when machine returned, keep electrode pads)
•	Attend pelvic physio appointments and group sessions; monitor effect on symptoms and pain
•	Engage in 2024 group sessions
HCP:
•	Discuss options and provide resources
•	Discuss pelvic physio and book appointment
•	TENS machine demonstration
•	Provide group session information when available	•	Review methods tried, what works well, what doesn't
•	Encourage/explore new methods
•	Further resources provided
•	Encourage participation in pain specific group sessions
•	Pain specialist referral if required 
	
Symptom management
•	Pharmacological
	•	Optimise pain management and physical function including during pain flares
•	Review medications
•	Patient's specific goals eg- improve sexual activity enjoyment, decrease pain with toileting
	Patient:
•	Provide current medication information and previous medication - name, dose, frequency, effect
•	Discuss goals of medication
•	Take medication only as advised
•	Monitor side effects and discuss with Nurse/GP/Pharmacist as required
•	Attend GP review after trial of any new medication
HCP:
•	Discuss with GP:
•	Goals of medication
•	Non-hormonal: eg- anti-inflammatory options
•	Hormonal: eg- contraceptive pill, IUD
•	GP to provide advice, any relevant prescriptions and follow up, or send advice back to regular GP for prescribing	•	Review effect on symptoms and if changes required
•	Pain specialist referral if required
•	Review patient's specific goals	
Manage Periods	•	Manage symptoms
•	Optimise medication and other management
	Patient:
•	Discuss pharmacological and non-pharmacological options and follow advice given
•	Monitor effect of different management methods trialled
HCP:
•	Discuss different options for managing symptoms - eg ways to manage bleeding (cup, underwear etc), pain management, GIT symptom management
•	Discuss pharmacological and non-pharmacological options and provide resources/scripts as appropriate	•	Review methods tried, what works well, what doesn't	
Sexual function	•	As per patient's needs eg- reduce pain and improve enjoyment if sexually active	Patient:
•	Discuss with GP +/- pelvic physio
•	Follow advice given by physio, implement exercises/relaxation as directed at home
•	Consider sex therapist or other referral if appropriate
HCP:
•	Pelvic physio appt given
•	Referrals as needed	•	Review effect on symptoms
•	Consider sex therapist	
Fertility	•	Optimise fertility if desired	Patient:
•	Discuss plans with GP to facilitate any tests or referrals as needed
HCP:
•	Provide relevant referrals,  hormone testing, pregnancy/pre-conception advice where relevant	•	Ongoing discussion	
Mental/emotional health	•	Monitor fatigue, low mood
•	Prioritise good sleep hygiene
•	Manage depression/anxiety or other symptoms	Patient:
•	Review resources provided
•	Consider mental health care plan and psychology
•	Attend relevant group sessions
•	Identify any activities that can still be enjoyed during pain flares
•	Identify support people
•	Connect with professional support where needed
HCP:
•	Review at each visit
•	Consider if Mental Health Care Plan and psychology referral may be of assistance
•	Resources for psychology and mental health provided	•	Review each visit
•	Repeat DASS21 +/- any other questionnaires
•	Psychology referral from GP if required	
Gastrointestinal symptoms	•	Reduce bloating/pain
•	Ensure soft regular bowel motions	Patient:
•	Implement/consider diet advice as given, monitor effects on symptoms, monitor trigger foods
•	Consider resources given
•	Good toilet positioning; use of stool softeners via diet or medication
•	Attend pelvic physio
•	Attend relevant group sessions in 2024
•	Consider dietitian
HCP:
•	Dietary advice and resources given
•	Advice on stool softeners given
•	Specialist referral if required	•	Ongoing review and referrals	
Bladder symptoms	•	Reduce any irritability and improve function	Patient:
•	Avoid triggers for irritable bladder eg caffeine, smoking, artificial sweeteners
•	Ensure adequate water intake
•	Trial double voiding to improve emptying
•	Pelvic physio
HCP:
•	Advise on the above
•	Specialist referrals if needed	•	Ongoing review	
Social support	•	Communicate with friends/family and work for support	Patient:
•	Identify reliable support people/groups
•	Share information and resources with partner/s, friends, family, employers as desired
•	Engage in group sessions in 2024
HCP:
•	Advice and resources given
•	Resources that can be shared with partner/s, friends, family, employers
•	Advise of group session info when available	•	Ongoing review	
Manage exacerbations (flares)	•	Have a plan for pain flares	Patient:
•	Monitor and record anything that helps your pain and symptoms, and what doesn't
•	Trial different symptom management methods as discussed
•	Medications as prescribed/advised
•	Engage with supports - professional and social/personal
•	Identify pain triggers or early warning signs of pain
HCP:
•	Provide Flare Plan document and assist patient to develop theirs, utilising information above (usually done at the second nurse appointment)	•	Create, review and adjust Flare Plan	

Team Care Arrangements
Provider type (eg pelvic health physio)	Provider details	Provider goals	

			

Additional notes on above plan:

Date: <TodaysDate>
Consent: I agree with the goals of this care plan; I understand the recommendations and that details of my medical history may be discussed with other providers if needed

___________________________					_____________________________
PATIENT SIGNATURE							DOCTOR SIGNATURE

- Copy of Care Plan offered to patient and relevant providers
- Plan for review of GPMP/TCA discussed with patient
- Planned review date: