Health Screening and History of an Adolescent or Young Adult Client

Health History and Screening of an Adolescent or Young Adult Client
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Student Name:NicckiDaneeta

Date:1/16/2018

Biographical Data

Patient/Client Initials: ND

Phone No:NA

Address: 11018 Kentucky Ave Whittier, CA 90500

Birth Date:21ST JUNE 1994

Age:26

Sex:FEMALE

Birthplace: Whittier, CA

Marital Status: SINGLE

Race/ Race/Ethnic Origin:Africam-American

Occupation: college student

Employer: NA

Financial Status: (Income adequate for lifestyle and/or health concerns. Is there a source of health insurance? Employment disability?)
She lives and relies on both parents. She is covered by the mothers health insurance plan. Gets financial support from both parents.

Source and Reliability of Informant:mother and patient

Past Use of Health Care System and Health Seeking Behaviors:
none

Present Health or History of Present Illness:
Abdominal pain with menustration.

Past Health History

General Health: (Patient’s own words)
Has not experienced any health problems in the past one month.

Allergies: (include food and medication allergies)
No allergies

Reaction:
NA

Current Medications:
NA

Last Exam Date:3/7/2016

Immunizations:
UTI

Childhood Illnesses:
NONE

Serious or Chronic Illnesses:
NONE

Past Health Screening (see “Well Young Adult Behavior Health Assessment History Screening” below)
YEARLY BREAST EXAMINATION AND PAP SMEAR

Past Accidents or Injuries:NONE

Past Hospitalizations:outpatient for the treatment of a UTI

Past Operations:
NONE

Family History
(Specify which family member is affected.)

Alcoholism (ETOH use/abuse):FATHER

Allergies: FIRST COUSIN IS ALLERGIC TO ASPRIN

Arthritis:NONE

Asthma:NONE

Blood Disorders:NONE

Breast Cancer:NONE

Cancer (Other):NONE

Cerebral Vascular Accident (Stroke):PATERNAL GRANDMOTHER

Diabetes: NONE

Heart Disease:NONE

High Blood Pressure: PARTENAL GRANDFATHER

Immunological Disorders:NONE

Kidney Disease: MOTHER

Mental Illness:NONE

Neurological Disorder: FIRST COUSIN

Obesity: NONE

Seizure Disorder:NONE

Tuberculosis: SISTER

Obstetric History (if applicable)

Gravida:NA

Term:NA

Preterm:NA

Miscarriage/Abortions:NA

Course of Pregnancy (length of pregnancy, delivery date, method of delivery, length of labor, complications, baby’s weight, baby’s condition):N/A







Well Young Adult Behavioral Health History Screening

Socio-Demographic Content and Questions:
What organizations or activities (community, school, church, lodge, social, professional, academic, sports) are you involved in?
ATTEND CHURCH EVERY WEEK
FULL TIME COLLEGE STUDENT
How would you describe your community?
SAFE
Hobbies, skills, interests, recreational activities?
SWIMMING, READING, HIKING AND GOING TO VACATIONS
Military service: Yes_______ No_____X__
If yes, overseas assignment? Yes________ No___X______
Close friends or family members who have died within past 2 years?
Partenal grandfather
Number of relatives or close friends in this area?
Entire family
Marital status: Single___x___ Married________Divorced_________Separated_________ In serious relationship________Length of time_________

Environmental Content and Questions:
Do you live alone? Yes________ No ___x_____
When did you last move?
Moved in 2014 to accommodate the growing family
Describe your living situation?
Lives with both parents and 2 siblings
Number of years of education completed?
Completed high school and possibly to graduate from college in 2019
Occupation?
no
If employed, how long?
NA
Are you satisfied with this work situation?
NA
Do you consider your work dangerous or risky?
NA
Is your work stressful?
NA
Over the past 2 years have you felt depressed or hopeless?
YES

Biophysical Content and Questions
Have you smoked cigarettes? Yes_______ No______X__
How much? NA
Less than ½ pack per day_____ About 1 pack per day?______ More than 1 and ½ packs per day______
Are you smoking now? Yes_______ No___X_____ Length of time smoking?______________
Have you ever smoked illicit drugs? Yes____X______ No_________
If yes, for how long? ____ONCE_______ Do you smoke these now? Yes__________ No ___X_______
Do you ingest illicit drugs of any kind? Yes_________ No_____X_____
If so, what drugs do you use and what is the route of ingestion?__N/A_______
How long have you used these drugs_____N/A____________

Review of Systems
(Include both past and current health problems. Comment on all present issues.)

General Health State (present weight – gain or loss, reason for gain or loss, amount...