FAMILY COPING INDEX

Head of the Family: ________________________ Date: __________________

Type of Family: ___________________________ No. of Family: __________
No. of Family Members:__________
Address:________________________________________________________

Family Coping Areas Rating Assessed Problems Justification

Physical Independence

Therapeutic
Competence

Knowledge of Health
Conditions

Application of
Principles of General
Hygiene

Health Attitudes

Emotional Competence

Family Living

Physical Environment

Use of Community
Facilities
 Example
FAMILY COPING INDEX

Head of the Family: ________________________ Date: __________________

Type of Family: ___________________________ No. of Family: __________
No. of Family Members:__________
Address:________________________________________________________

Family Coping Problems

Rating Justification
Areas Assessed
Physical 5 None The family is capable of doing
Independence their activities of daily living
independently
Therapeutic 3 Lack of financial Mrs. XY has lack of maintenance
Competence resources to avail in medication because according
maintenance to her, she don’t practiced taking
medication medications because it has no
cure being given and it is
expensive.
Knowledge of 3 Not enough Mrs. XY verbalized that she
Health Condition knowledge in lessen her intake of sweets but
health condition she is not aware of increased in
salt can contribute to bad health.
She also does exercise in the
morning.
Application of 3 Lack of action in The family have improper
Principles of cleaning their disposal of garbage and the
general Hygiene surroundings. stagnant water is near their house.
As we can see the mosquitos are
breeding to the stagnant water.
Health Attitudes 3 They don’t have Mrs. X once verbalized that they
first aid kit and don’t have enough money to buy
they do not have medications especially to their
regular check-up. grandchildren.
they don’t trust
the services given
by the
government or
private health
institutions.

Source:
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.slideshare.net
%2Fhomeworkping7%2F207528705-
familycasestudy1&psig=AOvVaw3RjUCRNmkkhSwZTZ_x5Rhx&ust=1598665027316000&source=images
&cd=vfe&ved=0CAMQjB1qFwoTCICHo7-tvusCFQAAAAAdAAAAABAD