Get Answer: Create Example Health Question Guide

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Original Question

Create an Example Health History Patient and Nurse Inteview of a Male Diabetic Patient. Fill up the form with the possible answers of a Diabetic Patient. Create your own answers. COMPREHENSIVE HEALTH HISTORY Date:_________________ DEMOGRAPHIC Name:____________________________ Age:____ Gender:__________________ Nationality:___________ Marital Status:______ Language spoken:______________ Occupation:_______________ HEALTH HISTORY Problems at birth:_______________________ Allergies (Food or Medications) State reactions:_________________________________________________ Childhood Illnesses:_______________________________________________________ Immunizations:___________________________________________________________ Previous Illnesses: _________________________________________________________________________ Previous Surgeries: ________________________________________________________________________ Implanted medical devices (e.g. Pacemaker, Titanium implants):__________________________________ Pregnancies: Total Birth: _____ Miscarriage:______ Abortions:____ Stillbirths:________________ Accidents or Injuries:______________________________________________________________________ Disability / Mobility problems:________________________ Assistive devices needed:__________________ Mental health concerns (e.g. stress, depression):_________________________________________________ Medications Generic (Brand Name) Dosage and Frequency Route Late dose taken FAMILY HEALTH HISTORY Hereditary disorders Relationship to the patient SPECIFIC HEALTH HISTORY: SUBSTANCE USE Substance Quantity Stimulants Coffee (specify brand) Energy drink (specify brand) Alcohol Wine (specify brand) Beer (specify brand) Hard Liquor (specify brand) Cigarette Smoking Vape Recreational drugs / Prohibited drugs SOCIAL, EDUCATION, RELIGION AND RECREATIONAL Religion and Religious practices Educational Attainment Living accommodation (House, Apartment, Condominium) Living arrangement (With partner, family, alone, friends) HEALTH PROMOTION PRACTICES Sleep (On the average number of hours of sleep) Diet (Rate: Good, Fair, Poor) Activities: Sports and exercise (specify specific activity and duration) USE OF MEDICAL RESOURCES Services Frequency utilized Doctor Dentists Other health professionals (specify if any and how frequent do you visit them):_______________________________________________________________________________ DIAGNOSTIC AND LABORATORY TEST Diagnostic and Laboratory Test done within the last 1 year. Test Normal / Abnormal results Findings SOURCES OF HEALTH INFORMATION Where do you get your Health formation (Select all that apply)? ( ) Allied Health Professional (e.g. Physician, Nurse) Please specify:_____________________________ ( ) Website, Please specify:________________________________ ( ) TV Shows, Please specify:______________________________ ( ) Others (e.g Folk leaders, Social media), Please specify:_________________________

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