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Family Assessment Guide
Family Assessment Guide
COLLEGE OF NURSING
163 E. Mendiola St., Manila
Telefax: (02) 734. 7921
I. Demographic Data
Husband: __________________________
Wife: __________________________
Others: __________________________
Father: __________________________________________________________
Mother: __________________________________________________________
Children: __________________________________________________________
K. Containers used
_____ plastic pitchers _____ jars, clay pots
_____ bottles _____ others, specify _________________
A. Common illnesses encountered for the last 6 months and the treatment
applied.
VI. Environment
1. Kind of neighborhood
2. Social and health facilities available
3. Communication and transportation facilities
F. Name 5 formal and non-formal leaders of the community whom you think
can lead the people.
1.
2.
3.
4.
5.
______________________________________________________________________
* Adapted from the Family Health Management Manual for Nursing Students Community Exposure Book 1 By Lydia C.
Viet, RN, MAN