Health History Worksheet - Term Paper Example

Health History Worksheet This worksheet is used to assist the in gathering and organizing information when conducting a Health History. Family Member Description Paternal grandfather First and last initials: SM Birthdate: 1933 Death date: 1994 Occupation: Retired as Plumber Education: 7th grade Primary language: English Health summary: He was diagnosed with diabetes, high blood pressure and high cholesterol. He died from a road accident. Paternal grandmother First and last initials: KM Birthdate: 1940 Death date: 2009 Occupation: Housewife Education: 4th grade Primary language: English Health summary: He was diagonised with Diabetes, high blood pressure and asthma. She died from an asthma attack. Father First and last initials: JO Birthdate: 1957 Death date: Still alive Occupation: Businessman Education: College degree Primary language: English Health summary: He was diagnosed with diabetes. He died of a heart attack. Father’s siblings- Summary of any significant health issues The father’s 2 brothers have been diagnosed with high blood pressure. Maternal grandfather First and last initials: TP Birthdate: 1928 Death date: 2002 Occupation: Army General Education: 8th grade Primary language: English Health summary: He was diagnosed with being obese, and had high cholesterol. He died from stroke. Maternal grandmother First and last initials: AP Birthdate: 1935 Death date: 2008 Occupation: House wife Education: 3rd grade Primary language: English Health summary: She was diagnosed with breast cancer and high blood pressure. She died from heart failure. Mother First and last initials: RO Birthdate: 1965 Death date: Still alive Occupation: Teacher Education: College degree Primary language: English Health summary: She was diagnosed with ovarian cancer. Mother’s siblings- Summary of any significant health issues Adult Participant First and last initials: HL Birthdate: 1982 Death date: Still alive Occupation: Physician Education: Graduate medical education (GME) Primary language: English Health summary: He was diagnosed with diabetes and high blood pressure. Adult participant’s siblings Summary of any significant health issues All have not been diagnosed with significant health issues Adult participant’s spouse/significant other First and last initials: DL Birthdate: 1984 Death date: Still alive Occupation: Banker Education: University degree Primary language: English Health summary: Has not been diagnosed with significant health issues Adult participant’s children- Up to 4 children Child #1 first and last initials: GL Birthdate: 2004 Death date: Alive Occupation: Too young to be employed Education: 5th grade Primary language: English Health summary: Has not been diagnosed with any significant health issues Child #2 first and last initials: OL Birthdate: 2007 Death date: Alive Occupation: Too young to be employed Education: 3rd grade Primary language: English Health summary: Has been diagnosed with asthma. Child #3 first and last initials: SL Birthdate: 2010 Death date: Alive Occupation: Too young to be employed Education: Kindergarten Primary language: English Health summary: Has not been diagnosed with any significant health issues Child #4 first and last initials: KL Birthdate: 2012 Death date: Alive Occupation: Too young to be employed Education: Hasn’t started school Primary language: English Health summary: Has not been diagnosed with any significant health issues Read More