Family Assessment tools:

Name: NAWAL M. ABDULGAFOR

Age: 25
Sex: FEMALE
Religion: ISLAM
Status: SINGLE
Address: LOT 16, BLOCK 16, AGREDA PHASE 2, BRGY. SANTO NIÑO, KORONADAL CITY,
SOUTH COTABATO

FAMILY PROFILE
Name Age Alive Educational Occupation Health Role in the family
or late attainment Status
Ex: alleb 21 ALIV College Accountant Asthmati breadwinner
E graduate c
NAWAL 25 ALIV College Financial Ulcer breadwinner
E graduate Analyst
ABDULGAF 69 ALIV College none Diabetic, Decision Maker
OR E graduate High
blood
H. SALIHA 63 ALIV College none Diabetic Disciplinarian
E Graduate
HISAM 28 ALIV Undergraduate OFW Diabetic Decision
E Maker
/Mediator/Rescuer
IBRAHIM 31 ALIV College Administrative None Protector
E Graduate Aide
AMAL 23 LATE

Type of family
(nuclear, extended, blended)
 Who lives in your house?
Genogram
1st generation (grandparents)
Name Alive or late Age (if late, age at Disease (leave it
death) blank if none)
Grandmother from Hadja Rocaya Alive 93 HIGHBLOOD
mother side
Grandfather from Hadji Yusoph late 90 HIGHBLOOD,
mother side DIABETIC
Grandmother from late 89
father side
Grandfather from late 87
father side

2nd generation siblings of your mother (in order) * add box if needed
name Alive or late Age (if late, age at Disease (leave it
death) blank if none)
Sibling 1 NAHARA ALIVE 29
Sibling 2 NADJMA ALIVE 26
 Sibling 3 NIHAYAH ALIVE 24
Sibling 4 MOHAMMAD ALIVE 19
RAJIE
Sibling 5 NURHANSA ALIVE 17
Sibling 6 NASRIMA ALIVE 15

2nd generation siblings of your father (in order) * add box if needed
name Alive or late Age (if late, age at Disease (leave it
death) blank if none)
Sibling 1 IISA ALIVE 45 DIABETIC
Sibling 2
Sibling 3
Sibling 4

3rd generation: you and your siblings (in order) * add box if needed
name Alive Age (if Disease Role in the Live in the
or late late, age (leave it blank family house or not
at if none)
death)
Sibling 1 NAWAL ALIVE 25 ULCER BREADWINN YES
ER
Sibling 2 AMAL LATE 24 NONE
Sibling 3
Sibling 4
 Role in the family: breadwinner, caregiver (the one who takes care the family like doing cooking,
cleaning)
APGAR
Part 1
Almost always Some of the time Hardly ever
I am satisfied that I can turn to my family for
help when something is troubling me

Comment:
I am satisfied with the way my family talks
over things with me and shares problems
with me 

Comment:
I am satisfied that my family accepts and
supports my wishes to take on new activities
and directions 

Comment:
I am satisfied with the way my family
expresses affection and respond to my
emotions 

Comment:
 I am satisfied with the way my family and I
share time together

Comment:
*if you answer hardly ever, pls explain why in the comment

Part 2

Who lives in your home? How do you get along

Name Relationship Age Sex Well Fairly poor

HADJA MOTHER 63 FEMALE

SALIHA

If you don’t live with your family, list the persons whom How do you get along
you turn to for help?
Name Relationship Age Sex Well Fairly poor
HADJA AUNT 60 FEMALE 
AISHA

*Just add more box for your more answers

Family Circle
Instruction:

Size of the circle represent their significance in your life.

Distance of circle represent your relationship to that person. Like close or not or less interaction
Use a clean bond paper or any paper and draw the circle. Just take a picture of it then send it to via pm
Answer the following question base on the circle you draw:

1. What if you remove a significant member of the circle? Name and why?
 Aunt 1 & Aunt 2 causing a problem all the time
 2. Who do you run to for support?
 My Siblings
3. How would you like things to be different?
 There are a lot of things
o Settling in life is important for my family whereas I like to chase my passion
o I am different from the rest of the family as I tell the truth and I'm outspoken. I'm
an extrovert and I'm honest. I'm also the easiest to get along with and very down
to earth

4. Who is missing in the circle? Why? Grandmother, grandmother, because even though she is still
alive it seems like she is no longer in the world because her other children do not respect her.
because of the properties.
5. Why are there inside the circle?
6. Who is in the power position (who made decisions for the family or who is in control)? Uncle 2
7. Who are the people you are going to grouped together? Uncle 2

Example of circle:

SCREEM
1. How is the social interaction among the family members?
Answer: hardly to interact with my family and relative because everyone is busy with their
business and work
2. Does your activities outside limit your time with your family?
Answer: in times of work, Yes.
3. How often each of you have time for conversation?
Answer:
4. Do you all practice same religion, culture and ethnicity?
5. Answer: YES
6. How will you describe (strict, negotiable or open) your religion rulings?
7. Answer: Strict
8. Do you feel satisfying spiritual experiences with your religion?
9. Answer: Yes
10. Who among the family earn money?
Answer: Me and My siblings
11. Who provide money for the expenses at home? How did you divide the expenses among the
family member?
 Answer: Me, 50% of my Salary is allocated for the medicines of my Parents, 20% allowance and
grocery for my parents, then 30% for my daily expenses
12. Who financially support your parents?
Answer: Me
13. Do you think your family is financially stable to satisfy your family needs?
Answer: No
14. Does anyone in your family has comprehension problem?
Answer: yes
15. Do all the member of the family has medical insurance (like philhealth)?
Answer: Yes
16. Do you have reserve money in case of medical emergency?
Answer: Yes

Put x in the box

When someone in our family Strongly Agree Disagree Strongly

gets sick … Agree Disagree

We help each other in our ×

family

Our friends and people in ×

our community are helpful
to our family

Our culture gives our family ×

strength and courage

Our culture of ×
helpfulness, caring and
concern in our
community is helpful to
our family.

Our faith and religion are ×

helpful to our family

Members of our church ×

and/or religious groups are
helpful to our family

Our family’s savings are ×

sufficient for our needs

Our family’s income is ×

sufficient for our needs

Our knowledge and education ×

 is
sufficient for us to
understand the
information about
the illness

Our knowledge and education ×

is
sufficient for us to take
care of our sick family
member

Medical help is readily ×

available in our
community.

Doctors, nurses and/or ×

health workers in our
community are helpful to
our family

Family Map (name the family member and how)

1. Does anyone in your family is overly involve in others life (like in decision, clothing, daily
activity)? ex: mother wanted to accompany her college student son during enrollment or in
shopping
Answer: Sibling 2, wants to build a house but he doesn't have the budget so he asks me for
money.
2. Is there anyone in the family who emotional isolate himself from the other family member?
Answer: No
3. Is there anyone in the family “detached” from the family?
Answer: None

Family lifeline (family event)

List the significant event in your life that has an impact to you (start from birth and in order
Year Age List of life event Psychological impact rate 1-10
2010 14 Graduation from Elementary School 9
2012 16 Death of my sister 10
2013 17 Father married another woman 10
2013 17 Car Accident of my father from abroad 5
2014 18 Graduation from High School 7
2015 19 Difficulties in studies 8
2017 21 Father terminated from his job 10
2018 22 Graduation from College 10
2018 22 Began working-difficulties of 10
workloads
2022 25 Mild stroke of my father 8
2022 25 Promoted from work 7

Example