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    Family Folder

    Uploaded by

    alokasthana1010
    This document contains a family folder template to collect health and demographic information about families. The template includes sections to document: [1] identification data of the head of household; [2] housing conditions; [3] family composition and health status; [4] transportation and communication access; [5] languages known; [6] nutritional status; [7] illness history; [8] pregnant women; [9] eligible couples for family planning; [10] where treatment is sought when sick; and [11] a care plan and nurses' notes. The collected information will help healthcare providers assess families' needs and plan appropriate care.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Family Folder

    Uploaded by

    alokasthana1010
    31 views6 pages
    This document contains a family folder template to collect health and demographic information about families. The template includes sections to document: [1] identification data of the head of household; [2] housing conditions; [3] family composition and health status; [4] transportation and communication access; [5] languages known; [6] nutritional status; [7] illness history; [8] pregnant women; [9] eligible couples for family planning; [10] where treatment is sought when sick; and [11] a care plan and nurses' notes. The collected information will help healthcare providers assess families' needs and plan appropriate care.

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    This document contains a family folder template to collect health and demographic information about families. The template includes sections to document: [1] identification data of the head of household; [2] housing conditions; [3] family composition and health status; [4] transportation and communication access; [5] languages known; [6] nutritional status; [7] illness history; [8] pregnant women; [9] eligible couples for family planning; [10] where treatment is sought when sick; and [11] a care plan and nurses' notes. The collected information will help healthcare providers assess families' needs and plan appropriate care.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    31 views6 pages

    Family Folder

    Uploaded by

    alokasthana1010
    This document contains a family folder template to collect health and demographic information about families. The template includes sections to document: [1] identification data of the head of household; [2] housing conditions; [3] family composition and health status; [4] transportation and communication access; [5] languages known; [6] nutritional status; [7] illness history; [8] pregnant women; [9] eligible couples for family planning; [10] where treatment is sought when sick; and [11] a care plan and nurses' notes. The collected information will help healthcare providers assess families' needs and plan appropriate care.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 6

    FAMILY FOLDER

    Submitted to:- Submitted By


    FAMILY FOLDER
    Primary Health Centre …………………………………………………………Sub Centre ……………………………………………

    Name of the Village ………………………………………………………………………………………………………………………….......

    I. IDENTIFICATION DATA

    a) Head of the family Name:- ………………………………………………………………………………………………………………….

    `b) Address :- …………………………………………………………………………………………………………………………..

    ………………………………………………………………………………………………………………………………………

    c) Type of family : Nuclear Joint

    d) Religion : Hindu Christian Muslim Any Other

    II. HOUSING CONDITION:

    a) Type of House: Completed I independent Tiled Sheeted Hut Own Rented

    b) Rooms : Number Adequate Inadequate

    c) Kitchen : Separate Attached to room

    d) Fuel Used : Gas Kerosene Fire wood Electricity

    e) Ventilation : Adequate Inadequate

    f) Bathroom : Separate Common

    g) Lighting : Electricity Oil Lamp

    h) Drainage : Open Closed

    i) Water Supply : Tap hand pump Well/Tube Well chlorinated yes/no

    j) Lavatory : Own Public Open field

    k) Disposal of Waste: Compositing Burning Burying

    l) Cattle Shed : Separate Within the houses

    m) Diet : Vegetarian Non Veg.


    III FAMILY COMPOSITION

    Relationship Health Immunization


    S. Name with head Age Sex Education Occupation Status Status
    N of the
    o. family

    IV TRANSPORT AND COMMUNICATION

    a) Transport

    Own Yes No

    Tractor Tempo Two Wheeler Bus City Bus UPSRTC

    Private Auto Taxi Train

    b) Communication Media
    Yes No
    Telephone/Mobile

    Television

    Radio

    News Paper/Magazines

    Post & Internet

    V. LANGUAGES KNOWN

    English Hindi Other


    VI. NUTRITIONAL STATUS OF FAMILY MEMBERS

    Name of the Member Nourished/Under Malnutrition BMI


    Nourished

    VII. RECORD OF ILLNESS

    Name of the Member Age Duration Main characteristics Investigation Treatment


    of disease done

    VIII. PREGNANT WOMEN

    Name Age Gravida/Para No. of Registered in Receiving T1


    & LMP EDD Children Hospital/Nursing Iron & Folic T2
    living Home Acid (Vaccine)
    IX .ELIGIBLE COUPLES

    S. Name Age F.P. Method Not interested in Willing to Adopt


    No Adopted F.P.

    X. IN CASE OF SICKNESS, WHERE DO YOU GO FOR TREATMENT

    (I) Hospital PHC Sub Centre


    (ii) Private Nursing Home

    (iii) Indigenous Doctor Dai

    XI. BASED ON ABOVE DATA WRITE A CARE PLAN (MINIMUM-3) FOR YOUR PATIENT AND GIVE CARE
    AS PER PRIORITY.

    Problem/Need Assessment Objective Nursing Intervention Evolution


    XII. NURSES NOTES

    Date Time Nurses Notes Signature

    Teacher’s Signature Student’s Signature

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