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COMMUNITY FAMILY ASSESSMENT

Head of the Family:____________________________


Address:_____________________________________

Date:_____________________

Community Profile
Lapaz is one of the six districts of Iloilo City, Philippines. Brgy. Ticud, is bounded after Iloilo City
Proper and before Balabago, Jaro. It is bounded on the North of Brgy. San Isidro. Baldoza on the South,
Brgy. Cainginon the East and Brgy. Ingore on the West. Three zone compose the Barangay: Zone 1, 2 and
3. It is 5 kilometers away from its Provincial. The total land area is 94, 253 square meters, has no
farmland and has 437 residential lots.
Has a total population of 2, 535 and a total household of 422 based on the 2009 survey.
Family Profile
A. Family Structure
Name

Age

Sex

CS

Educational
Attainment

Relationship to the
head of the family

1.
2.
3.
4.
5.
6.
7
8.
9.
10.
B. Socio-economic and Cultural Characteristics
a. Income and expenses of each family member
NAME
1.
2.
3.
4.
5.
6.
7.

OCCUPATION

MONTHLY
INCOME

MONTHLY
EXPENSES

NET INCOME

b.Other resources
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C. Home Environment
a. Housing
a.1 Adequacy of Living Space/Housing Materials/
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a.2 Water Supply and Drainage
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a.3 Food Storage and Cooking Facilities
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a.4 Toilet Facility and Garbage/Refuse Disposal
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b. Kind of Neighborhood/Social and Health Facilities/Transportation and Safety
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C. Health Status and Practices of Each Family Member


a. Eating/Feeding Habits/Practices
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b. Sleeping Habits/Rest and Relaxation
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c. Healthy and Unhealthy lifestyle practices (e.g Good hygiene, use of footwear, smoking/drinking)
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d. Values, Habits and Practices on Health Promotion, Maintenance and Disease Prevention
d.1 Immunization Status
Name

Age

Immunizations Received

Doses

Remarks

d.2 Use of Promotive-preventive health services(regular check-up, maintenance meds, etc)


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e. Past/Present Illness/Diseases
e.1 Diseases/Illnesses Inherited and experienced by each member of the family
Name of family member

Disease/Illness

Consultation/
Hospitalization

Date

Remarks

e.2 Other present illness/diseases and other disabilities


Name of Family
member

Disease/Illness
/disabilities

Signs and
Symptoms

Treatment/
Interventions

Remarks

Remarks:
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Assessed by: ___________________________

Date:_____________________

Noted by:______________________________

Date:_____________________

Clients Signature:_______________________

COMMUNITY NURSING FAMILY ASSESSMENT


Nursing Assessment is the first major phase of the nursing process. The Family health nursing
practice, involves a set of actions by which the nurse measures the status of the family as a client, its
ability to maintain itself as a system and functioning unit , and its ability to maintain wellness and well
being among its members.
There are three major steps in nursing assessment as applied to family nursing practice: Data
collection, data analysis and family nursing diagnoses. The First-Level Asessment includes identification
of presence of wellness condition, presence of health threats, presence of health deficits and presence
of stress points/foreseeable crisis condition. The Second-Level assessment data include those that
specify or describe the familys realities, perceptions about and attitudes related to the assumption or
performance of family health tasks on each health condition or problem identified during the first level
assessment.
The Community Nursing Family Assessment is a tool use to assess wellness potential, health
threats, and health deficit based on clients performance, current competencies or clinical data.
Wellness potential is a nursing judgment on wellness state or condition based on clients current
competencies or performance and clinical data to achieve a higher level of state or function in a specific
area on health promotion and maintenance. Health Threats are conditions that are conducive to
disease and accidents, or may result to failure to maintain wellness or realize health potential. Health
Deficits are instances of failure in health maintenance.
Each family then is classified depending on the absence and presence of illness/disease, health
threats, health deficits and the maintenance of health based on the assessment. They will be classified
as Class A Family, Class B Family and Class C. Class A family are families with the absence of health
threats, health deficit and able to maintain/promote wellness. Class B family are those with absence of
health deficit but with health threats and has potential for wellness, while Class C family are families
with health deficit and health threats but has potentials and readiness to improve and enhance wellness
state.

Community Profile
Lapaz is one of the six districts of Iloilo City, Philippines. Brgy. Ticud, is bounded after Iloilo City
Proper and before Balabago, Jaro. It is bounded on the North of Brgy. San Isidro. Baldoza on the South,
Brgy. Cainginon the East and Brgy. Ingore on the West. Three zone compose the Barangay: Zone 1, 2 and
3. It is 5 kilometers away from its Provincial. The total land area is 94, 253 square meters, has no
farmland and has 437 residential lots.