Health Care Checklist

PKU Toolkit - A Guide to PKU Management for Teens and Young Adults - Produced by Children's Hospital Boston, Applied Nutrition, and the New England Consortium of Metabolic Programs

How well am I managing my own health care right now?

This checklist can help you find out how well your managing your own health care. Transitioning to adult health care is a positive thing because you will be treated as an adult. However, this process also means taking on responsibilities.

Answer the following questions to find out some of the simple things you are already doing or can start doing for better management of your own health care!

18 - 24 Statements
Super! You are already taking on adult responsibilities. You are ready to transition to adult health care!

8 - 17 Statements
You are on your way! You are actively taking on many responsibilities in your health care! Pick a few more responsibilities from the checklist to do for your next appointment!

0 - 7 Statements
As we know, transition means change and change takes time and planning. Now is a good time to start taking on more responsibility in your health care. Set small easy to handle goals! Pick one new responsibility from the checklist and practice it at your next appointment! If you need help, don't hesitate to ask a friend, parent, nurse, social worker or doctor!

1. I know my height, weight, birth date and social security number.

Yes No

2. I know the name of my condition.

Yes No

3. I can tell you about my PKU and explain my special health care needs.

Yes No

4. I know what kind of medical insurance I have.

Yes No

5. I know where to find my medical records.

Yes No

6. I know the basics of PKU treatment.

Yes No

7. I know what my diet should include and should not include.

Yes No

8. I know how to prepare my own foods.

Yes No

9. I know how to shop for my foods.

Yes No

10. If I do take formula, I know the name of the formula.

Yes No

11. I know how to order my formula.

Yes No

12. I know about special low protein foods.

Yes No

13. I monitor my blood Phe levels.

Yes No

14. I know about maternal PKU and its implications.

Yes No

15. I have discussed sexuality issues with my provider.

Yes No

16. I know how to get birth control and protection from sexually transmitted diseases.

Yes No

17. I have discussed the use of tobacco, alcohol and drugs with my provider.

Yes No

18. I know how to schedule a medical appointment.

Yes No

19. I keep a schedule of my medical appointments on a calendar.

Yes No

20. I can get myself to my medical appointments.

Yes No

21. I know who to call in case of an emergency.

Yes No

22. I respond to questions from my health care providers.

Yes No

23. I prepare questions for my health care providers.

Yes No

24. I have a support network for PKU.

Yes No

18 - 24 Statements
Super! You are already taking on adult responsibilities. You are ready to transition to adult health care!

8 - 17 Statements
You are on your way! You are actively taking on many responsibilities in your health care! Pick a few more responsibilities from the checklist to do for your next appointment!