My health passport
The aim of this passport is to help you record down the information
of your family doctor, dentist or Chinese medicine practitioner. It is
also your personal health record. Please keep it properly.
Please remember to bring along your health passport for every
health visits. This will help your family doctor, dentist, Chinese
medicine practitioner and other healthcare professionals
understand your health conditions and facilitate discussion of your
health promotion plan.
Page
Content
1. Information of My Family Doctor
2
2. Information of My Family Dentist
3
3. Information of My Family Chinese Medicine Practitioner 4
4. My Personal Health Information
5
5. My Consultation Record (Family Doctor)
6
6. My Consultation Record (Family Dentist) 8
7. My Consultation Record
(Family Chinese Medicine Practitioner)
8. Tips for Healthy Lifestyle
11
9. Health Reference Index
15
10. Health Commitment
16
11. Resource Corner
20
1
9
1. Information of My Family Doctor
(To be filled by your family doctor)
My family doctor: (Name)
(To be filled by your family dentist)
My family dentist: (Name)
Please affix the name card of
your family doctor.
My family doctor has joined the following primary
care schemes:
Health Care Voucher
Scheme
Yes/No
Elderly Vaccination
Subsidy Scheme
Yes/No
2
2. Information of My Family Dentist
Please affix the name card
of your family dentist.
My family dentist has joined the following primary
care scheme:
Health Care Voucher
Scheme
3
Yes/No
3. Information of My Family Chinese Medicine Practitioner
4. My Personal Health Information
(To be filled by your family Chinese medicine practitioner)
(To be filled by oneself)
Date of birth :
My family Chinese medicine
practitioner: (Name)
Sex :
Address :
Telephone :
Blood type :
Medical history :
Please affix the name card of your
family Chinese medicine practitioner.
Drug allergy (Western medicines /
Chinese medicines):
Food allergy :
Long-term medication(s) (Western medicines /
Chinese medicines):
My family Chinese medicine practitioner has joined
the following primary care scheme:
Health Care Voucher
Scheme
Yes/No
Emergency contact
In case of emergency, please contact the following
persons:
Name
4
Relationship
5
Telephone
number
5. My Consultation Record (Family Doctor)
(To be filled by oneself)
Date
Time
Diagnosis
6
5. My Consultation Record (Family Doctor)
(To be filled by oneself)
Date
Time
Diagnosis
7
6. My Consultation Record (Family Dentist)
7. My Consultation Record (Family Chinese Medicine Practitioner)
Date
Date
(To be filled by oneself)
Time
Diagnosis
8
(To be filled by oneself)
Time
Diagnosis
9
7. My Consultation Record (Family Chinese Medicine Practitioner)
8. Tips for Healthy Lifestyle
(To be filled by oneself)
Date
Time
Diagnosis
Adopt healthy
eating habit
‧
Eat a balanced diet; maintain ideal body weight
‧
Ensure balanced nutrition and eat more high
fibre food such as vegetables, fruits, whole wheat
bread and brown rice
‧
Adopt healthy cooking methods like steaming,
poaching or boiling
‧
Reduce intake of high fat food such as animal
fat and skins, fried food, whole milk, cakes or
coconut milk
‧
Pay attention to the values of fats, sodium (or
salt) and sugar on nutrition labels. Choose food
lower in fats, sodium and sugars.
Increase
physical
activities
‧
Exercise for at least half an hour daily; or
‧
Exercise for at least one hour every other day; or
‧
Accumulate 30 minutes of physical activities daily
(not less than 10 minutes each time).
Reduce
alcohol intake
10
‧
No more than 2 standard drinks daily for male
‧
No more than 1 standard drink daily for female
11
8. Tips for Healthy Lifestyle
‧
A standard drink (note 1) equals to:
- 250 ml of beer (5% alcohol)
- 1 small glass (100 ml) of wine (12% alcohol)
- 1 pub measure (30 ml) of spirits (40% alcohol)
Quit smoking
‧
Non-smokers should not try smoking and smokers
should quit immediately
‧
‧
Relax your
body and mind
Oral hygiene
‧
‧
Health Preservation in Chinese Medicine
The key concept of health preservation in Chinese medicine is
“preventing disease before its occurrence”, which means to promote
health, prevent diseases and enhance longevity in accordance with the
theories of Chinese medicine.
1. Maintain a healthy mental state
If you need help to quit smoking, please refer to
Learn to maintain a balanced state of mind, stay relaxed, calm and
Resource Corner
happy
Stay relaxed; don't be too stressful
2. Adapt to the nature and seasonal changes
Spring : preserve yang qi; select mild and relaxing outdoor activity;
Brush your teeth properly twice a day
Use toothbrush with soft bristles and fluoride
toothpaste Clean all surfaces of your teeth
properly, i.e. the outer, inner and chewing
surfaces; and gently brush the gumline
‧
8. Tips for Healthy Lifestyle
Use dental floss or interdental brush to clean
space between teeth
eat light
Summer : prevent summerheat; prevent excessive consumption of
body fluids; eat light; avoid raw and cold food
Autumn : preserve body fluids; maintain indoor humidity; gradually
put on more clothes to keep war m; eat food that
replenishes yin and moisten dryness, e.g. pear, honey etc.
Winter : keep warm; take hot food and beverages; avoid excessive
spicy food
3. Exercise regularly
Choose suitable types of exercise and exercise regularly
Note 1: A standard drink contains 10g of pure alcohol.
12
13
8. Tips for Healthy Lifestyle
4. Maintain a healthy diet
9. Health Reference Index
You may check your weight, blood pressure, glucose level, oral hygiene
‧ Pay attention to food hygiene
and body conditions against the following indices to see if you are doing
‧ Beware of dietary contraindications. For examples, those with heat
well. If you have chronic diseases, your reference indices may differ.
body constitution should avoid eating excessive hot and spicy
food, such as chilli, chives and ginger, etc; elderly people should
protect their spleen and stomach, eat light, take soft and warm
food.
‧ Eat a balanced diet with appropriate temperature and suitable
amount of food at regular time. Don't be a picky eater
5. Maintain a controlled and healthy sex life
Maintain a controlled and healthy sex life to avoid excessive use of
Health Reference Indices
Body Mass Index (BMI)
Below 23 kg/m2 (note 2)
Blood pressure
Below 140/90 mmHg
Glucose level
Fasting level below 6.1 mmol/L (note 3)
Oral hygiene
No plaque or calculus accumulating on teeth or
gum; no swelling, inflammation or bleeding gum.
Body condition
With a conscious and clear mind; bright eyes;
bright complexion; regular breathing pale
red tongue; thin white coating on the tongue;
normal voice; clear speech; and no abnormal
smell
kidney-essence which may lead to poor health or premature aging
6. Health-strengthening massage
Massage body parts or acupoints in a balanced and soft manner;
consult your family Chinese medicine practitioner for detailed
Note 2: Body Mass Index (BMI) is defined as the weight in kilograms divided by the
manipulation
square of the height in metres. World Health Organization recommended
Body Mass Index (BMI) cut-off points for overweight as 25 kg/m 2 and
obesity as 30 kg/m2 in 2004. For Asian populations, the BMI cut-off points
of 23 kg/m2 and 27.5 kg/m2 were added as points for public health action.
Central obesity (for Chinese) is defined as waist circumference for man
equal to or more than 90 cm and for woman equal to or more than 80 cm.
Note 3: Fasting is defined as no food intake for 8 hours or more.
The above information is for reference only. If you have any query, please consult your family
doctor, dentist or Chinese medicine practitioner.
14
15
10. Health Commitment
10. Health Commitment
Do you want to be healthy? Please discuss with your family doctor,
dentist or Chinese medicine practitioner your health promotion plan
every year and make an effort to achieve it.
Do you want to be healthy? Please discuss with your family doctor,
dentist or Chinese medicine practitioner your health promotion plan
every year and make an effort to achieve it.
Date:
In the next 12 months, I will meet these targets:
(Please tick against the items)
Date:
In the next 12 months, I will meet these targets:
(Please tick against the items)
Sleep and get up early; make a habit of working in daytime and
resting at night; adapt to seasonal changes;
Sleep and get up early; make a habit of working in daytime and
resting at night; adapt to seasonal changes;
Stay relaxed, calm, happy and ventilate _negative emotion
Stay relaxed, calm, happy and ventilate _negative emotion
Brush and clean teeth properly and thoroughly, day and night
Brush and clean teeth properly and thoroughly, day and night
Use toothbrush with soft bristles and fluoride toothpaste
Use toothbrush with soft bristles and fluoride toothpaste
Use dental floss or interdental brush to clean space between teeth
Use dental floss or interdental brush to clean space between teeth
Eat less salty food
Eat less salty food
Eat less fried food; use less oil in cooking
Eat less fried food; use less oil in cooking
No over eating
No over eating
Dine out less often; prepare lunch by myself
Dine out less often; prepare lunch by myself
Eat more high fibre food such as vegetables, fruits and whole grains food
Eat more high fibre food such as vegetables, fruits and whole grains food
Observe food hygiene; beware of dietary contraindications; eat a
balanced diet with appropriate temperature and amount at regular
time
Observe food hygiene; beware of dietary contraindications; eat a
balanced diet with appropriate temperature and amount at regular
time
Choose suitable types of exercise and exercise regularly
Choose suitable types of exercise and exercise regularly
Massage body parts or acupoints in a balanced and soft manner
Massage body parts or acupoints in a balanced and soft manner
Quit smoking
Quit smoking
Drink less alcohol
Drink less alcohol
Maintain a controlled and healthy sex life
Maintain a controlled and healthy sex life
Follow doctor's advice on medication(s)
Follow doctor's advice on medication(s)
16
17
10. Health Commitment
10. Health Commitment
Do you want to be healthy? Please discuss with your family doctor,
dentist or Chinese medicine practitioner your health promotion plan
every year and make an effort to achieve it.
Do you want to be healthy? Please discuss with your family doctor,
dentist or Chinese medicine practitioner your health promotion plan
every year and make an effort to achieve it.
Date:
In the next 12 months, I will meet these targets:
(Please tick against the items)
Date:
In the next 12 months, I will meet these targets:
(Please tick against the items)
Sleep and get up early; make a habit of working in daytime and
resting at night; adapt to seasonal changes;
Sleep and get up early; make a habit of working in daytime and
resting at night; adapt to seasonal changes;
Stay relaxed, calm, happy and ventilate _negative emotion
Stay relaxed, calm, happy and ventilate _negative emotion
Brush and clean teeth properly and thoroughly, day and night
Brush and clean teeth properly and thoroughly, day and night
Use toothbrush with soft bristles and fluoride toothpaste
Use toothbrush with soft bristles and fluoride toothpaste
Use dental floss or interdental brush to clean space between teeth
Use dental floss or interdental brush to clean space between teeth
Eat less salty food
Eat less salty food
Eat less fried food; use less oil in cooking
Eat less fried food; use less oil in cooking
No over eating
No over eating
Dine out less often; prepare lunch by myself
Dine out less often; prepare lunch by myself
Eat more high fibre food such as vegetables, fruits and whole grains food
Eat more high fibre food such as vegetables, fruits and whole grains food
Observe food hygiene; beware of dietary contraindications; eat a
balanced diet with appropriate temperature and amount at regular
time
Observe food hygiene; beware of dietary contraindications; eat a
balanced diet with appropriate temperature and amount at regular
time
Choose suitable types of exercise and exercise regularly
Choose suitable types of exercise and exercise regularly
Massage body parts or acupoints in a balanced and soft manner
Massage body parts or acupoints in a balanced and soft manner
Quit smoking
Quit smoking
Drink less alcohol
Drink less alcohol
Maintain a controlled and healthy sex life
Maintain a controlled and healthy sex life
Follow doctor's advice on medication(s)
Follow doctor's advice on medication(s)
18
19
Resource
1
Corner
1.
Smoking cessation service
Organisation
Service
Integrated Smoking
Cessation Hotline of the
Department of Health
Hospital Authority
Quitline
Department of
Health
1833 183 (press 1)
1833 183 (press 3)
2300 7272
Hospital Authority
Women Smoking
Cessation Service
The University of
Hong Kong
Tung Wah Groups of
Hospitals Smoking
Cessation Hotline
Tung Wah
Groups of
Hospitals
Pok Oi Smoking Cessation
Service using Traditional
Chinese Medicine
Telephone number
2819 2692
1833 183 (press 2)
2332 8977
Pok Oi Hospital
1833 183 (press 4)
26071222
Related Websites
Oral Health Education
Unit, Department of Health
http://www.toothclub.gov.hk/
http://www.cheu.gov.hk/
Central Health Education
Unit, Department of Health
Chinese Medicine
Division, Department of
Health
Smart Patien1, Hospital Authority
http://www.cmd.gov.hk/
http://www21.ha.org.hk/
Health Service Hotlines
Oral Health Education Unit, Departmen1 of Health
2713 6344
24-hour Health Education Hotline, Central Health
Education Unit, Department of Health
Chinese Medicine Division, Department of Health
20
2833 0111
25749999