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Family Data

A. Family Structure, Characteristics and Dynamics/Relational Patterns

1. Members of the household:

Name Birthdate Sex Civil Status Position in the family Relationship to the head of the family

Rewen Apolacio 2-2-73 F Married Mother Wife

Reymund Apolacio 9-9-70 M Married Father Husband

Ryan John Apolacio 12-14-97 M Single Brother Son

Wendy Anne Apolacio 10-16-99 F Single Daughter Daughter

2. Sociodemographic data of members not currently living in the household but with

major role in resource generation and use: Grandmother (age, employment and income)

3. Type of family structure and form: Nuclear Family

4. Dominant family members in terms of decision making and care tending: Both Mother

and Father

5. Family dynamics, communication pattern/s, interactional processes and interpersonal

relationships which possess innate or great potential to mediate or potentiate factors relevant

to health, illness, growth, development and the family’s ability to handle conflict, change,

anticipated and unexpected events: informal communication, family bonding, discuss family

matters and problem

B. Socio-economic and Cultural Characteristics

1. Income and Expenses

a) Occupation, place of work and income

1. Ryan- LTO enforcement. Income: 7,000

2. Rowen- Self-employed. Income: 15,000

3. Reymund- Government employee: 40,000

b) Adequacy to meet basic necessities: Adequate

c) Who makes decision about money and how it is spent: Both parents

2. Educational attainment of each member:

a) Rewen- College Graduate

b) Reymund- College Graduate

c) Ryan- College Graduate

d) Wendy- College Graduate

3. Ethnic background and religious affiliation: Roman Catholic

4. Family traditions, events or practices affecting members’ health or family functioning:


5. Significant Others: play as a role of a parent

6. Relationship of the family to larger community: participate in various barangay


C. Home and Environment

1. Housing

a) Adequacy of living space: 350 sq. meters

b) Sleeping arrangement: each has own room

c) Presence of breeding or resting sites of vectors of diseases: flies, mosquitoes and


d) Presence of accident and fire hazards: electric posts

e) Food storage and cooking facilities: refrigerator, stove, microwave, toaster

f) Water supply: MIWD- no supply

g) Toilet facility: ownership, made from marble, sanitize and clean

h) Garbage/refuse disposal: segregate non-biodegradable and biodegradable, sanitize

and clean

i) Drainage system: well function drainage system, unclogged

2. Kind of neighborhood: spacious

3. Social and health facilities available: health center (barangay)

4. Communication and transportation facilities available: tricycle and jeepneys

D. Health Status of each Family Member

1. Medical and nursing history indicating current or past significant illnesses or beliefs

and practices conducive to health and illness- cancer, stroke, diabetes (genetics)

2. Nutritional assessment a.) Anthropometric data, b.) eat fruits and vegetables, drink

water, in take vitamins and maintenance for high blood pressure

3. Developmental assessment of infants, toddlers, and preschoolers:

4. Risk factor assessment indicating presence of major and contributing modifiable risk

factors for specific lifestyle diseases- hypertension, lack of physical activities

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

1. Immunization status of family members :

2. Healthy lifestyle practices: Not eating junk foods

3. Adequacy of:

a) Rest and sleep- 6 hours a day

b) Exercise/activities-

c) Use of protective measures- using pesticides, insecticides and air fresheners

d) Relaxation and other stress management- sleeping, talking, reading

e) Openness in terms of communication within the family : talking

4. Use of promotive-preventive health services and use of healthy lifestyle-related

services- Acquiring medical insurance for all the members of the family