HEALTH HISTORY RUBRIC

Name: ________________________________________________ Date: ________________

TASK Poor (1pt) Fair (2pts) Good (3pts) Excellent (4pts) Score
FAMILY HEALTH HISTORY
The family as a whole The information The information is The information is The information is
provided comprehensive but comprehensive and comprehensive, complete
limited, incomplete and relevant and but includes and relevant data that
incomplete and irrelevant data incomplete data hence adequately supports
irrelevant data inadequately supports assessment of the family as a
family assessment whole.
Family Morbidity Data are limited, Data are Data are comprehensive, Data are provided in
inorganized and comprehensive but and organized but includes organized manner,
has irrelevant inorganized and has irrelevant information comprehensive and relevant
information. irrelevant information hence unable to show that supports family
significant health practices assessment.
of the family
Family Mortality and Data are limited, Data are Data are comprehensive, Data are comprehensive,
Genogram inorganized and comprehensive, but organized bur have limited organized and complete
does not have inorganized and Genogram of three genogram up to three
genogram limited genogram generations hence unable generations that reveals
to reveal complete family family mortalities.
mortality
PAST HEALTH HISTORY
Significant health-related Data are arranged in Data are arranged in Data are arranged in presentable
Data provided are
factors and lifestyles presentable manner, but presentable manner and manner, comprehensive and
not in order,
has limited information comprehensive but adequately excellent past health assessment
limited, and
that insufficiently provides supports analysis of health- that allows outstanding synthesis
irrelevant
analysis related lifestyles. leading to significant findings.
Relevant health experiences Information are comprehensive,
Information are comprehensive,
and morbidities and its organized in presentable manner,
Information are Information are organized in presentable
management complete and adequately provide
limited, comprehensive but manner and complete but
relevant and significant
disorganized, and disorganized and inadequately provide relevant
information that allows synthesis
incomplete incomplete and significant information that
of overall health experience of
allows synthesis.
the patient.
PRESENT HEALTH HISTORY
Order of events / Timeline The information
are presented in The information are
The information are presented
disorganized presented in organized The information are presented in
in organized manner and
manner, unable to manner but unable to trace organized manner and provides
provides earliest onset of the
trace back earliest back earliest signs and earliest onset of the disease and
disease but does not follow
signs and symptoms and does not follows content/timetable
content/timetable
symptoms and does follow content/timetable
not follow content
Identification of signs and Information are comprehensive,
Information are comprehensive,
symptoms including its Home organized in presentable manner,
Information are Information are organized in presentable
remedies and other complete and adequately provide
limited, comprehensive but manner and complete but
management relevant and significant
disorganized, and disorganized and inadequately provide relevant
information that allows synthesis
incomplete incomplete and significant information that
of overall health experience of
allows synthesis.
the patient.

TOTAL SCORE ______

28 pts

_______________________________
NAME AND SIGNATURE OF CLINICAL INSTRUCTOR

_________________
DATE SUBMITTED