Assessment of an Adolescent.docx - Assessment of an...

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Assessment of an Adolescent (age 13-17 years) Student(s) Age of Client Person(s) Interviewed _________ child _________ mother _________ father _________ other: _________________________________________ Current Medical History (list, if any; if none, indicate NONE) Allergies (medications, food, other; if none, indicate NKA) Substance Reaction Current Medications Name Indication
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Complementary and Alternative Modalities in Health Care (herbals, supplements, chiropractic, shaman; if none, indicate NONE) Name Indication Description Date/Year Residual Problems Previous medical conditions Previous hospitalizations Injuries
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Surgeries Current Immunization Status Are immunizations up-to-date? (If No, explain parent’s rationale) Reactions to vaccines (list, if any and to which one(s); if none, put NONE Newborn Course Findings (Do not use ‘normal’, ‘within defined limits’, etc.) Birth History (Gestational age and growth pattern) APGAR (Apgar score and type of resuscitation if required) Neonatal Complications (Respiratory, infections, feeding, hyperbilirubinemia, congenital abnormalities) Family Detail
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Placement in the family Family structure Cultural heritage Impact of culture on health care beliefs and practices ( NONE is not an option ) Family genetic Concerns
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