HOME VISIT REPORT #1

(Please save the Home Visit Report as a Word Document before sending)

Although every family visited has signed a HIPAA release, please do not use family names, addresses or phone numbers in your reports. Use initials only. Date of Visit: 10/2/13 Your Name: Jacquelyn Sousa Your Email: jsousa@ufl.edu Your Phone Number: (727) 631 4994 Your Familys Phone Number: N/A Initials, ages and relationships of family members present at this visit: Initials Age Relationship EG 60s Grandmother N/A 15 Granddaughter

How do you rate the following:

1. Your teams communication with volunteer family on this visit? X Excellent Good Fair Poor 2. Your teams communication over setting time and date for visit? X Excellent Good Fair Poor 3. Communication between team members and family during the visit? X Excellent Good Fair Poor 4. The level of teamwork in your student team in planning the visit (i.e. scheduling visit, planning who would do what, completing assigned tasks)? X Excellent Good Fair Poor 5. The team members collaboration/participation during the visit? X Excellent Good Fair Poor 6. What is your overall rating of this home visit? X Excellent Good Fair

Poor NEXT PAGE

Were there any problems with this home visit that concern you? (For example, any problems with scheduling the visit, with the conduct of the team during the visit, the assignments, problems with any particular family members, concerns about your safety, etc.) (If so, have you notified your small group leaders and the main office at 273-5320)? N/A

Write a few sentences about the following: The most important things you learned about the family during this home visit (e.g., attitudes about health and the health care system, social support, affects of illness on the family system, their quality of life. etc.). Any cultural aspects that you need to take into account when working with this family? She is the caregiver of her granddaughter with Cystic Fibrosis. Her family seems to be her support system. While speaking to Mrs. Gardner she did not seem concerned about any health issues of her own and seemed to live a content and satisfying life. Her only wish is to have help gardening vegetables to use this as a way to relieve stress.

Describe your comfort level and the familys comfort level meeting a new person in their home environment. How did this impact your visit? Please note any other general impressions you have after the visit. Mrs. Gardner was very welcoming and friendly. She seemed to enjoy having company and speaking with us. While conversing she seemed relaxed and comfortable sharing information with us. Mrs. Gardner has been participating in the IFH program for several years.