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FAMILY ASSESSMENT

Family Name:Lusay
Address:Jagobiao, Mandaue City

I. Demographic Data
Household No.: SA 082

II. Family Data

Length of Residency: 20 years


Place of Origin:
Husband:Esparanza, Zamboanga City
Wife: Asturias, Cebu city

Family Size: 1
Religion:
Husband: Roman Catholic
Wife:Roman Catholic

Family Member’s Chart

CIVI
AG SE L POSITION IN THE RELATIONSHIP TO EDUCATIONAL
FAMILY MEMBER OCCUPATION
E X STA FAMILY THE FAMILY HEAD ATTAINMENT
TUS
High School
Allan 43 M M Head ------- Tricycle Driver
Graduate
College
Marilyn 38 F M Mother Wife ECS Gratuity Worker
Undergraduate
Almarie 13 F S Oldest Daughter Daughter 2nd Year High School Student

Marie Grace 12 F S Youngest Daughter Daughter 1st Year High School Student

III. Family Characteristics

Family Structure: Nuclear

General Family Relationship/ Dynamics

STATU
CRITERIA ADDITIONAL INFORMATION
S
Observable conflicts between family members - No presence of conflict
Characteristics of communication + Uses moderate tone of voice
Interaction patterns among member - Good communication pattern

Family Dietary Habits

Breakfast: Coffee, Rice, Bread, Boiled egg


Lunch: Rice, Vegetable
Supper: Rice, Fried Fish
Monthly Family Income Source
Husband: P300 per day
Wife: P2, 000 per month with sari-sari store 2,500 per month

Monthly Family Income


P12, 500

Family Health Status/ Health History


Father: Back pain; normal BP (120/80mmHg)
Mother: Dizziness; normal BP (90/70mmHg)
Oldest Daughter: Fever, Cough and Colds
Youngest Daughter: Fever, Cough and Colds

Felt Family Needs


1. House and Lot
2. Financial

IV. Home and Environment


A. Is your lot owned? NO
B. Is your house owned? YES
C. Type of housing materials? MIXED
D. Is the living space adequate? YES
E. What are the appliances owned by the family? REFRIGERATOR, TELEVISION
F. Type of garbage disposal? COLLECTION ( every Friday)
G. Type of waste disposal? FLUSH
H. Type of drainage system? OPEN
I. Source of water supply? MCWD; Mineral water for Drinking
J. Drinking water storage? COVERED
K. Container used? GALLOON
L. Food storage/ cooking facilities? COVERED/ REFRIGERATOR; WOOD
M. Common household pest found at home? RATS, COCKROACHES, MOSQUITOS
N. Are there breeding site present? YES ( rocks and stagnant water )
O. Pets/ Animal kept in the yard or home? NONE
P. Are there accident hazard present? NONE

V. Health and Health Practices


A. Common illnesses encountered for the last 6 months and the treatment applied.
Fever, Cough and Colds ------ Medication taken : Biogesic, Bioflu
B. Whom do you consult for health related problems?
Hospital and Health Centers
C. For problems other than health, whom do you consult?
Neighbors
D. Immunization status of the family members?
Complete Immunization
E. Have you had adequate
1. Rest and sleep? YES ( 8-10 hours a day )
2. Exercise? NONE
3. Relaxation activities? YES ( watching television )
4. Stress management activities? NONE
VI. Environment
1. Kind of neighborhood URBAN
2. Social and health facilities available HOSPITAL; HEALTH CENTER;
GYMNASIUM
3. Communication and transportation facilities MOTORCYCLE; JEEPNEYS

VII. Awareness of Community Organization


A. Are you aware of existing organization in the community? YES
B. Name all the organization you know? SAN ANTONIO CHAPEL ORGANIZATION
C. Are you a member of any of these organizations? YES
D. Are you aware of its activities and projects? YES
E. How are you involved in its activities? ATTEND MEETINGS
F. Name 5 formal and non-formal leaders of the community whom you think can lead the people.
1. Fe Buenavista
2. Editha Montesa
3. Noynoy Aquino

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