Health History and Screening of an Adolescent or Young Adult Client
Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include the relevant data for your client. Submit this resource with your assignment to the instructor by the end of Module 3.
|Student Name: Oluwaseun Obajolu |Date:08/16/2012 |
|Biographical Data | |Patient/Client Initials :A.A |Phone No:6469320857 | |Address:1105 Farley drive, Randallstown, MD | |Birth Date:05/03/1995 |Age:17 |Sex: Male | |Birthplace: Lagos, Nigeria |Marital Status: Single | |Race/Ethnic Origin: African | |Occupation: Student |Employer: N/A | |Financial Status: | | | |Client is a full time student who currently gets health insurance under his mother’s health insurance coverage | |Source and Reliability of Informant: Self and Mother. | | | |Past Use of Health Care System and Health Seeking Behaviors: Yearly physicals at Pediatrician’s. Currently loves to exercise in order to keep | |fit and healthy | | | |Present Health or History of Present Illness: Client has a past medical history of Malaria. | |Past Health History | |General Health: I am in good general health at the moment | | | |Allergies: No known medication or food allergy. |Reaction: | | | | | |Not Applicable | |Current Medications: | |None | |Last Exam Date:08/2010...
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