CommunityHealthNursing1(IndividualandFamilyasClients)-RLE

Module#5Teacher’sGuide
FAMILY HEALTH ASSESSMENT FORM
Family surname: ESTRADA

House No. #44 Street: DEL PRADP ST.

Barangay: POBLACION NORTE District:

Municipality/ City: SANTA BARBARA Contact No.: 09309523607

Source (s) of information: AIDA C. ESTRADA

Data gathered by: PRINCESS JOY C. ESTRADA Date: MAY 13,2022
Household members:

Name Age Relationship to head of

Household

MARIO G. ESTRADA 62 FATHER

AIDA C. ESTRADA 59 MOTHER

MARK BRYAN C. ESTRADA 34 BROTHER

MARCLENE C. ESTRADA 32 BROTHER

AIRENE C. ESTRADA 31 SISTER

KIMBERLY MAE C. ESTRADA 29 SISTER

MARJON C. ESTRADA 27 BROTHER

MARIO C. ESTRADA, JR. 25 BROTHER

MARDE C. ESTRADA 22 BROTHER

MARK ANTHONY C. ESTRADA 21 BROTHER

PRINCESS JOY C. ESTRADA 19 DAUGHTER

 CommunityHealthNursing1(IndividualandFamilyasClients)-RLE
Module#5Teacher’sGuide

Note: Insert genogram, family tree (indicating health problems of individual members ), and/ or ecomap.
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Module#5Teacher’sGuide

FAMILY CHARACTERISTICS
Family members living outside the household
Name, age, and relationship to head of household

RIZALYN CABUTOTAN, 42 (AUNT)

Location of family member (s) SANTA BARBARA, PANGASINAN.

Frequency and duration of contact 2 TIMES A WEEK
Means of communication HOME VISITING
 CommunityHealthNursing1(IndividualandFamilyasClients)-RLE
Module#5Teacher’sGuide
Family Mobility
Length of time at current address
10 years

Address of previous residence (s)

TULIAO STA. BARBARA PANGASINAN

Frequency of geographic moves

NO HISTORY OF GEOGRAPHIC MOVES

Family Dynamics
Emotional Bonding of family members
BIBLE STUDY, WATCHING, EATING, AND TALKING

Distribution of authority and power

MY PARENTS HAS THE AUTHORITY POWER

Degree of individual autonomy

EVERYONE HAS AN EQUAL RIGHTS IN OUR FAMILY, BUT WE SHOULD KNOW OUR LIMIT.

How members communicate

ORAL AND TECHNOLOGICAL COMMUNICATION

How decisions are made

MY PARENTS ARE THE ONE WHO DECIDE.

How problems are solved

THERE ARE SO MANY PROBLEMS THAT WE ENCOUNTERED, AND I DON’T KNOW HOW MANY
TIMES WE SOLVED IT.

How conflict is handled

WE ARE OPEN TO EACH
OTHER, IN ORDER TO
RESOLVED THE
PROBLEMS.

Division of labor
IN OUR FAMILY WE HAVE A
DIFFERENT TASK IN
HOUSE CHORESTHAT
NEED TO DO.

SOCIOECONOMIC AND CULTURAL CHARACTERISTICS

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Module#5Teacher’sGuide

Family social integration

Language (s) or dialect ( s) spoken: PANGASINAN, TAGALOG, ENGLISH
Literacy ( ability to read or write in language (s) GOOD.
Degree of social network with friends, neighbors, and other relatives
Network with religious organizations. CHRISTIANITY
Network with social organizations. PRIVATEGROUP
Educational experiences.ELEMENTARY, HIGH SCHOOL, AND COLLEGE.
Work history NONE.
Adequacy of financial resources ENOUGH TO SUSTAIN OUR NEEDS
Leisure time interests EATING OUTSIDE
Cultural influences: values, attitudes, and beliefs about:
Spirituality CHRISTIAN (BORN AGAIN)

Rituals ( holidays and celebrations ) BIRTHDAY, CHRISTMAS, NEW YEAR, AND NATIONAL
HOLIDAYS.

Dietary habits HEALTHY LIFESTYLE

Health ALL GOOD.

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Module#5Teacher’sGuide

Folk diseases

Traditional Healers

FAMILY ENVIRONMENT

Family residence
Adequacy of size
1ST FAMILY

Structural safety
GOOD

Water sanitation
MINERAL/
DISTILLED WATER
ARE ALL GOOD
AND CLEAN
Food preparation and storage
FOOD PREPARATION ARE
ALL GOOD AND CLEAN,
ALSO SAFE TO EAT.
Sewage PIPE SEWAGE
SYSTEM
Garbage disposal
THERE’S GARBAGE
COLLECTOR IN
OUR MUNICIPAL
Excreta disposal
SEPTIC TANK
Pest and vermin control
INSECTICIDE SPRAY

Family neighborhood
Location (rural, urban, subdivision, slum area)
RURAL
Type( residential, semi commercial)
RESIDENTIAL
Safety
- Traffic patterns: NORMAL
- Lighting: DECORP
- Security ( police or private )
POLICE

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Module#5Teacher’sGuide
- Population
density(crowding)
NOT CROWDED
Sources of pollution
- Air- POLLUTED AIR
- Water- DIRTY RIVER WATER
- Soil- LOCAL WASTE DISPOSAL
- Noise- NORMAL CROWD NOISE
-
FAMILY HEALTH AND HEALTH BEHAVIOR
Activities of daily living (how family spends a typical day )
FAMILY DEVOTION, EATING, TALKING, SINGING, AND SLEEPING
Health history pregnancy, illness, death within the past 5 years/ health attendance )
HYPERTENSION, HEART DISEASE, AND CANCER.
Self care ( health promotion and disease prevention )
EXERCISE, EATING HEALTHY FOODS, AND HEALTHY LIFESTYLE.
Risk behaviors
NONE
Health status (problems and priorities)
GOOD, HEREDITARY AND PRIORITIZE
HEALTHY LIVING.
Home remedies
PRESCRIBED MEDICINES, HERBAL
MEDICINES, AND FIRST AID KIT.

Health care resources

- Health workers
- Health agencies PHIL HEALTH

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Module#5Teacher’sGuide

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