What principles did this person learn as a child that are still important to him/her?

1. How does the person describe current health?

1. What does the person do to maintain health?

1. What does person know about links between lifestyle and health?

1. How big a problem is financing health care for this person?

1. Can this person report his/her medications and the reason for taking them?

1. If this person has allergies, what does he/she do to prevent/manage them?

1. What does the person know about medical problems in his/her family?

1. Have there been any important illnesses/injuries in this person’s life?

1. Is this person well-nourished?

1. How does this person’s food intake compare with recommended food intake?

1. Does this person have any disease that affects nutritional/metabolic function?

1. Are the person’s excretory functions within normal range?

1. Does the person have any disease of the digestive system, urinary system, or skin?

1. How does this person describe his/her weekly pattern of:

Activity/Leisure?–Exercise/Recreation?

0. Does this person have any disease that affects his/her:

Cardio/Respiratory System?–Musculoskeletal System?

1. Does this person have any sensory deficits? If yes, are they corrected?

1. Can this person express himself/herself clearly and logically?

1. What is this person’s level of education?

1. Does this person have any disease that affects mental or sensory functions?

1. If this person has pain, describe it and its causes.

1. Describe this person’s sleep/wake cycle.

1. Does this person appear physically rested and relaxed?

1. Is there anything unusual about this person’s appearance?

1. Does this person seem comfortable with his/her appearance?

1. Describe this person’s feeling state.

1. How does this person describe his/her various roles in life?

1. Has, or does this person presently have positive role models for these roles?

1. Which relationships are most important to this person at this time?

1. Is this person presently going through any changes in role or relationships? If yes, describe changes.

1. Is this person satisfied with his/her situation related to sexuality?

1. Does this person have any disease/dysfunction of the reproductive system?

1. Is this person satisfied with his/her plans regarding children?

1. How does this person cope with difficult situations/problems?

1. Do these coping mechanism/actions help or make things worse?

1. Has this person had any treatment for emotional distress?

1. What principles did this person learn as a child that are still important to him/her?

1. Does this person identify with any social, religious, ethnic, regional, cultural, or other groups?

1. What support systems does this person currently have?