Health History and Screening of an Adolescent or Young Adult Client.

2574 Words11 Pages
Health History and Screening of an Adolescent or Young Adult Client Student Name: Biographical Data Patient/Client Initials: Phone No: Address: Birth Date: A Years Sex :Female Birthplace: Marital Status: Single Race/Ethnic Origin: Occupation: High School Student Employer: Unemployed Financial Status: (Income adequate for lifestyle and/or health concerns. Is there a source of health insurance? Employment disability?) She receives health insurance from parents. She is depended, and covered by her mother’s health insurance. Her parents financially support her. Source and Reliability of Informant: Source is the patient. Patient is very reliable, alert…show more content…
Serious or Chronic Illnesses: None. Socio-Demographic Content and Questions: What organizations or activities (community, school, church, lodge, social, professional, academic, sports) are you involved in? “I am a high school senior preparing to go into college next year. I am an altar server and attend church every Sunday. I am an active member of youth group in church, member of Indian club in the school. I also volunteer in American red cross and shadow a cardiologist two hours/ week. How would you describe your community? “My community is a very organized and has a diverse amount of people that are from various countries.” Hobbies, skills, interests, recreational activities? She has great interest in music and enjoys singing. She has a passion for dancing, she learned thirteen years Indian classical dance and performed throughout North America. Military service: Yes_______ No__X_____ If yes, overseas assignment? Yes________ No_________ Close friends or family members who have died within past 2 years? No Number of relatives or close friends in this area? 36 Marital status: Single X_____ Married________Divorced_________Separated_________ In serious relationship________ Length of time_________ Environmental Content and Questions: Do you live alone? Yes________ No __X______ When did you last move? I last moved 2000. Describe your
Open Document