Evidence-Based Preventative Care Checklist
For New Immigrants and Refugees

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Choose a region checklist:

• Caribbean
• Central & South America
• Eastern Europe
• Central Middle East
  • 1^st visit
  • 2^nd visit
  • 3^rd visit
  • Later visits
• North Africa
• South & Southeast Asia
• Sub-Saharan Africa

Legend:

Symbol	Meaning
	Links to an interactive synopsis of available evidence and recommendations for the condition.
	Links to the relevant section of the guidelines published in the Canadian Medical Association Journal.
	Links to the map.
Evidence links: The following two icons can appear in the checklist both individually (within squares), or as an add-on to the circle, diamond, and triangular shapes mentioned above. When they are used as add-ons, the alt text will include both the text associated with the main icon, and the text associated to the following two icons.
	Bold – CCIRH Recommendations
	Italics – Systematic Review Linked Evidence: US and Canadian Task For Preventative Care

Global Refugees Checklist
© CCIRH 2013 All Rights Reserved

Checklist: Central Middle East

Complete this online checklist or download the PDF version of the Central Middle East checklist (.pdf, 734 kb).

Note: When using the online version of the checklist, remember to print it before exiting the website. Your answers will not be saved.

Name:
Date:
Date of Arrival in Canada
Language(s) spoken:
Country of Origin:	Afghanistan Armenia Azerbaijan Bahrain Comoros Djibouti Georgia Iran Iraq Iraqi Kurdistan Israel Jordan Kazakhstan Kuwait Kyrgyzstan Lebanon Mauritania Oman Pakistan Qatar Sahrawi Arab Democratic Republic Saudi Arabia Somalia State of Palestine Syria Tajikistan Turkey Turkmenistan United Arab Emirates Uzbekistan Yemen
Family Supports:
Settlement/Refugee Claimant Worker:
Refugee Claimant Hearing Date:

1^st Visit

	Date:
Vital Signs	Ht: Wt: BP:
Patient Health Concerns	Address reason for visit; Patient-centered approach
Orientation	Clinic appointments and health system
Health History	Allergies, Current meds Previous Illness Immunization status
Psychosocial Assessment	Past education: Past occupation(s): Current housing: Migration/Displacement History: Remain alert to possible PTSD but do not routinely screen for history of trauma If linked to integrated program: Depression Screen Document date of refugee claimants-hearing
Education	Nutrition screening & counseling (programs to promote breastfeeding) Exercise programs to prevent obesity (active living) Screen for Unmet Contraceptive Needs/ Emergency Contraception Home visitation for high risk mothers (infant <3)
Physical Exam Important signs in immigrants from developing countries	Focused examination to address patient’s presenting complaint
Problems and Plan	Plan and book follow-up visit
Screening Investigations	CBC with differential (children/females) Hep B (sag/sab/cab)* Serology for Varicella* Do not perform a Mantoux test
Immunizations*	Children (Age Dependent): DPT-aP MMR HPV Varicella Adults: DPT MMR Varicella

2^nd Visit (2-7 days)

	Date:
Vital Signs	Wt: BP:
Patient Health Concerns	Address reason for visit; Patient-centered approach
Physical Exam Important signs in immigrants from developing countries	Screen Visual Acuity Dental Mouth Exam Nutritional status, fevers, scars/skin lesions, clubbing, wheezes, heart murmurs, lymphadenopathy, organomegaly, limb weakness
Problems and Plan	NSAIDs for Dental Pain and Refer for Dental pathology/pain
Screening Investigations	Fasting Glucose (>35) Screen for obesity LDL/Cholesterol (men>35, women >45) Remain alert for isolation for pregnant women

3^rd Visit (1-3 months)

	Date:
Vital Signs	Wt: BP:
Patient Health Concerns	Address reason for visit; Patient-centered approach
Orientation	Verify links to local resources (ie libraries, local events)
Psychosocial Assessment	Remain alert for adjustment stress, signs of child neglect / intimate partner violence Remain alert for possible onset of depression / PTSD
Education	Diet counseling (Iron Deficiency and Diabetes) Dental Care (tooth brushing) Adequate Vitamin D Positive Parenting Exercise Assess for Smoking and Alcohol misuse
Physical Exam Important signs in immigrants from developing countries	Ensure appropriate clothing for weather (cold and sun)
Problems and Plan	Refer if positive for Hepatitis B
Screening Investigations	Cervical cytology Consider testing for chlamydia; GC, syphilis (VDRL) Mammography (50-75) Fecal Occult Blood (>50) Osteoporosis screening (women >65)
Immunizations	Hepatitis B (non-immune) Varicella (non-immune) HPV vaccination (for 9-25 year old females)

Later visits (3-6 months)

	Date:
Vital Signs	Wt: BP:
Patient Health Concerns	Address reason for visit; Patient-centered approach
Orientation	Verify links to local resources (ie libraries, local events)
Psychosocial Assessment	Remain alert for adjustment stress, signs of child neglect / intimate partner violence Remain alert for possible onset of depression / PTSD
Education	Diet counseling (Iron Deficiency and Diabetes) Dental Care (tooth brushing) Adequate Vitamin D Positive Parenting Exercise Assess for Smoking and Alcohol misuse
Physical Exam Important signs in immigrants from developing countries	Ensure appropriate clothing for weather (cold and sun)
Problems and Plan	Refer if positive for Hepatitis B
Screening Investigations	Cervical cytology Consider testing for chlamydia; GC, syphilis (VDRL) Mammography (50-75) Fecal Occult Blood (>50) Osteoporosis screening (women >65)
Immunizations	Hepatitis B (non-immune) Varicella (non-immune) HPV vaccination (for 9-25 year old females)

*See Resource Page

Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the CCIRH preventative checklist is meant as a guide only.

Design and Production: Centre for e-Learning, Teaching and Learning Support Service (TLSS), University of Ottawa