Health History and Screening as a Young Adult

Health History and Screening of an Adolescent or Young Adult Client

Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include the relevant data for your client. Submit this resource with your assignment to the instructor by the end of Module 3.

|Student Name: Naomi Coleman                                                   |Date: July 24, 2012                                           |

|Biographical Data                                                                                                                             |
|Patient/Client Initials: E.K.                                                   |Phone No: 727-563-4536                                         |
|Address: 3719 39th Street N., Saint Petersburg, Florida 33713                                                                                 |
|Birth Date: 06/26/1984                                   |Age: 28             |Sex: Female                                                   |
|Birthplace: Saint Petersburg, Florida                                           |Marital Status: Single                                         |
|Race/Ethnic Origin: Caucasian                                                                                                                 |
|Occupation: Unemployed                                                         |Employer: Not Applicable                                       |
|Financial Status: (Income adequate for lifestyle and/or health concerns. Is there a source of health insurance? Employment disability?)       |
|                                                                                                                                               |
|Patient does not have adequate income to provide for the lifestyle she would like for her and her children. Since she does not have a job, she|
|does not have health insurance or any other benefits that may come with being...