Family Assessment Tools

Family Genogram

61 54
 Family Wellness Plan
Family Type of Problems Recommendations
Member Care
Arsenio 61 Screening BP, Cholesterol, Visual
yo
Acuity/Glaucoma, Fecalysis,
Driver Occult Blood, PTB Screening
Occasional (annual)
alcoholic
bev drinker Assessment of Hygiene
(+) eyeglass Dental Hygiene and Monitoring
(+) PTB
treatment Periodic Physical
Annual
2012 Examination

Practices and Health Bathing, Nails, Handwashing,

Practices Family Planning
 Family Wellness Plan
Family Type of Problems Recommendations
Member Care
Arsenio Screening Practices and Health Bathing, Nails, Handwashing, Family
Practices Planning

Assessment of Health Occupational Hazard, Sex Life

Risk
Behavior (with
monitoring)

Developmental Mental Prime MD

Monitoring
Marital relationship, Family relationship
Social

Health Consultation
Ill Health
Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Family Wellness Plan
Family Member Type of Care Problems Recommendations
Olimpia 54yo Screening BP, Cholesterol, Visual
Acuity/Glaucoma, Fecalysis,
Elementary Occult Blood, PTB Screening
Teacher (Grade 2) (annual)
45yo – eyeglass
(+) PTB treatment Self-Breast Exam and MD
2010 Breast Examination Exam regularly
(+) pneumoccal
vaccine Annual
Pap Smear and Pelvic
Examination
Annual
Rectal Examination Annual
PTB Screening
Annual
Periodic Physical
Examination
 Family Wellness Plan
Family Type of Care Problems Recommendations
Member
Olimpia Assessment of Hygiene Dental Hygiene and Monitoring
Practices and Health Practices Bathing, Nails, Handwashing, Family
Planning
Assessment of Health Risk
Behavior (with monitoring) Accident, Sex Life

Mental
Developmental Prime MD
Monitoring Social
Marital relationship, Family
relationship
Ill Health
Health Consultation
Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Family Wellness Plan
Family Member Type of Care Problems Recommendations
Evan Vic 31yo Screening Visual acuity/ Glaucoma Every 3 years

Single/ DOH ecalysis Annually for intestinal

Educ- Nursing parasites
graduate, RN PTB Screening PPD/Direct BCG annually

Periodic Physical Annual

Examination
Assessment of Hygiene Dental Hygiene and
Practices and Health monitoring
Practices Bathing, Nails, Lice,
Handwashing
Assessment of Health Risk Accident Exposure
Behavior (with monitoring)
Family Wellness Plan
Family Type of Problems Recommendations
Member Care
Evan Vic Developmen Physical Growth chart & nutrition & motor development
tal Learning disabilities, language
monitoring Mental Emotional & Moral development
Social

Ill health Consultation

Family Participation in Health Care
Education, Management, including Follow-up and
Referral
Health Health Personal hygiene
education Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Alwebb 30yo Screening Visual acuity/ Glaucoma Every 3 years

First year Fecalysis Annually for intestinal parasites

College
(Criminology) PTB Screening PPD/Direct BCG annually
(+) eye surgery
due to VA Periodic Physical Annual
Electrical (line Examination
man) Assessment of Hygiene Dental Hygiene and monitoring

Live in partner Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Alwebb Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Cyrus Lenard Screening Visual acuity/ Glaucoma Every 3 years
26yo
Fecalysis Annually for intestinal parasites
First year
college (crim) PTB Screening PPD/Direct BCG annually
Construction
worker Periodic Physical Annual
Examination
Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Cyrus Lenard Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Art Philip 23yo. Screening Visual acuity/ Glaucoma Every 3 years

Criminology 3rd Fecalysis Annually for intestinal parasites

year
PTB Screening PPD/Direct BCG annually

Periodic Physical Annual

Examination
Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Art Philip Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
John Nico 22yo Screening Visual acuity/ Glaucoma Every 3 years

Grade 5 Fecalysis Annually for intestinal parasites

Factory Worker
PTB Screening PPD/Direct BCG annually

Periodic Physical Annual

Examination
Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
John Nico Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Jerome 21yo Screening Visual acuity/ Glaucoma Every 3 years

BS fisheries Fecalysis Annually for intestinal parasites

PTB Screening PPD/Direct BCG annually

Periodic Physical Annual

Examination
Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Jerome Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Irvin 20yo Screening Visual acuity/ Glaucoma Every 3 years

BS education Fecalysis Annually for intestinal parasites

PTB Screening PPD/Direct BCG annually

Periodic Physical Annual

Examination
Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Irvin Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
April 18yo Screening Visual acuity/ Glaucoma Every 3 years

Civil Fecalysis Annually for intestinal parasites

engineering 1st
year PTB Screening PPD/Direct BCG annually

Periodic Physical Annual

Examination
Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
April Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Nikurt 15yo. Screening Visual acuity/ Glaucoma Every 3 years

Grade 9 Fecalysis Annually for intestinal parasites

PTB Screening PPD/Direct BCG annually

Periodic Physical Annual

Examination
Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Nikurt Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Lyndon 12 yo Screening Visual acuity/ Glaucoma Every 3 years

Grade 6 Fecalysis Annually for intestinal parasites

PTB Screening PPD/Direct BCG annually

Periodic Physical Annual

Examination
Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Lyndon Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Jandi 9 yo PWD Screening Visual acuity/ Glaucoma Every 3 years
Down syndrome
Fecalysis Annually for intestinal parasites
(-) maintenance
(-) schooling PTB Screening PPD/Direct BCG annually

For schooling Periodic Physical Annual

special class Examination
Tolosa Assessment of Hygiene Dental Hygiene and monitoring

Practices and Health Bathing, Nails, Lice,

Practices Handwashing

Assessment of Health Accident Exposure

Risk Behavior (with
monitoring)
 Family Wellness Plan
Family Member Type of Care Problems Recommendations
Jandi Development Physical Growth chart & nutrition & motor
al monitoring development
Health
Mental Learning disabilities, language

Social Emotional & Moral development

Ill health Consultation

Family Participation in Health Care
Education, Management, including
Follow-up and Referral
Health education
Personal hygiene
Sanitation issues
Junk food
Accident
Sexual development