Dec2

A. Family Structure, Characteristics and Dynamics

Name Relationship age gender Civil status Position in Place of

to the head the family residence
of
household

b. socio economic

Name Occupation Place of Income Highest ethnicity religion

work educational
attainment

C.

D.

Name Current health Fast significant Height Weight BMI

status illness

DEVELOPMENTAL ASSESSMENT

NAME AGE ERICK ERICKSON

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

1. Immunization Status of the Family

Mga vaccines

2. Healthy Lifestyle Practices