Levels Tought:
Elementary,Middle School,High School,College,University,PHD
Teaching Since: | Jul 2017 |
Last Sign in: | 206 Weeks Ago, 3 Days Ago |
Questions Answered: | 15833 |
Tutorials Posted: | 15827 |
MBA,PHD, Juris Doctor
Strayer,Devery,Harvard University
Mar-1995 - Mar-2002
Manager Planning
WalMart
Mar-2001 - Feb-2009
Health HistoryWorksheet
Thisworksheet is used to assist the student in gathering and organizing information when conducting a health history.
Family Member |
Description |
Paternal grandfather First and last initials: |
 |
Birthdate: |
 |
Death date: |
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Occupation: |
 |
Education: |
 |
Primary language: |
 |
Health summary: |
 |
Paternal grandmother First and last initials: |
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Birthdate: |
 |
Death date: |
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Occupation: |
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Education: |
 |
Primary language: |
 |
Health summary: |
 |
Father First and last initials: |
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Birthdate: |
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Death date: |
 |
Occupation: |
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Education: |
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Primary language: |
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Health summary: |
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Father’s siblings-Summary of any significant health issues |
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Maternal grandfather First and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
 |
Primary language: |
 |
Health summary: |
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Maternal grandmother First and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
 |
Primary language: |
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Health summary: |
 |
Mother First and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
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Primary language: |
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Health summary: |
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Mother’s siblings-Summary of any significant health issues |
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Adult Participant First and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
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Primary language: |
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Health summary: |
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Adult participant’s siblings Summary of any significant health issues |
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Adult participant’s spouse/significant other First and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
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Primary language: |
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Health summary: |
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Adult participant’s children- Up to 4 children |
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Child #1 first and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
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Primary language: |
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Health summary: |
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Child #2 first and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
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Primary language: |
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Health summary: |
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Child #3 first and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
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Primary language: |
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Health summary: |
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Child #4 first and last initials: |
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Birthdate: |
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Death date: |
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Occupation: |
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Education: |
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Primary language: |
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Health summary: |
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Â
Â
An example
Family Member |
Description |
Paternal grandfather First and last initials: |
RL |
Birthdate: |
1921 |
Death date: |
1981 |
Occupation: |
Retired as a coal miner |
Education: |
6th grade |
Primary language: |
English |
Health summary: |
He was diagnosed with chronic lung disease, diabetes, and hypertension. He died from a heart attack. |
Paternal grandmother First and last initials: |
ML |
Birthdate: |
1932 |
Death date: |
1998 |
Occupation: |
House wife |
Education: |
Does not want to disclose |
Primary language: |
English |
Health summary: |
Diagnosed with chronic lung disease from smoking cigarettes. Died from heart failure. |
This example points to common problems among this generation on both sides of the Adult Participant’s family. Consider the potential implications this would have for the Adult Participant’shealth status.
----------- Â ----------- H-----------ell-----------o S-----------ir/-----------Mad-----------am ----------- Th-----------ank----------- yo-----------u f-----------or -----------you-----------r i-----------nte-----------res-----------t a-----------nd -----------buy-----------ing----------- my----------- po-----------ste-----------d s-----------olu-----------tio-----------n. -----------Ple-----------ase----------- pi-----------ng -----------me -----------on -----------cha-----------t I----------- am----------- on-----------lin-----------e o-----------r i-----------nbo-----------x m-----------e a----------- me-----------ssa-----------ge -----------I w-----------ill----------- be----------- qu-----------ick-----------ly