,
,
, Student Response Model Documentation
would typically have a baked good for
breakfast, a sandwich for lunch, and a
meatloaf or chicken for dinner. Her snacks
consist of pretzels or French fries.
Immunizations: Tetanus booster was
ago. Does not perform breast self- received within the past year, influenza is
not current, and human papillomavirus has
not been received. She reports that she
exams. Last chest x-ray at 16. Last TB
believes she is up to date on childhood
skin test 2 years ago. No ECG.
vaccines and received the meningococcal
vaccine in college. Safety: Has smoke
detectors in the home, wears seatbelt in
car, and does not ride a bike. Does not use
sunscreen. Guns, having belonged to her
dad, are in the home, locked in parent’s
room.
• Mother: age 50, hypertension, elevated
cholesterol • Father: deceased in car
accident one year ago at age 58,
hypertension, high cholesterol, and type 2
diabetes • Brother (Michael, 25):
overweight • Sister (Britney, 14): asthma •
Tina has one brother and one sister. Maternal grandmother: died at age 73 of a
Father had diabetes and hypertension, stroke, history of hypertension, high
Family but died last year in a car accident. cholesterol • Maternal grandfather: died at
History Mother has hypertension. Grandfather age 78 of a stroke, history of hypertension,
had diabetes. Grandmother has high cholesterol • Paternal grandmother:
hypertension. still living, age 82, hypertension • Paternal
grandfather: died at age 65 of colon
cancer, history of type 2 diabetes • Paternal
uncle: alcoholism • Negative for mental
illness, other cancers, sudden death, kidney
disease, sickle cell anemia, thyroid
problems
Social Feels safe at home and work. No Never married, no children. Lived
History history of tobacco use. No one in independently since age 20, currently lives
household smokes. History of with mother and sister in a single family
smoking pot, last time was age 21. home to support family after death of
Drinks alcohol 1-2 times a week, few father one year ago. Employed 32 hours
drinks each time. Baptist religion. per week as a supervisor at Mid-American
,
, Student Response Model Documentation
would typically have a baked good for
breakfast, a sandwich for lunch, and a
meatloaf or chicken for dinner. Her snacks
consist of pretzels or French fries.
Immunizations: Tetanus booster was
ago. Does not perform breast self- received within the past year, influenza is
not current, and human papillomavirus has
not been received. She reports that she
exams. Last chest x-ray at 16. Last TB
believes she is up to date on childhood
skin test 2 years ago. No ECG.
vaccines and received the meningococcal
vaccine in college. Safety: Has smoke
detectors in the home, wears seatbelt in
car, and does not ride a bike. Does not use
sunscreen. Guns, having belonged to her
dad, are in the home, locked in parent’s
room.
• Mother: age 50, hypertension, elevated
cholesterol • Father: deceased in car
accident one year ago at age 58,
hypertension, high cholesterol, and type 2
diabetes • Brother (Michael, 25):
overweight • Sister (Britney, 14): asthma •
Tina has one brother and one sister. Maternal grandmother: died at age 73 of a
Father had diabetes and hypertension, stroke, history of hypertension, high
Family but died last year in a car accident. cholesterol • Maternal grandfather: died at
History Mother has hypertension. Grandfather age 78 of a stroke, history of hypertension,
had diabetes. Grandmother has high cholesterol • Paternal grandmother:
hypertension. still living, age 82, hypertension • Paternal
grandfather: died at age 65 of colon
cancer, history of type 2 diabetes • Paternal
uncle: alcoholism • Negative for mental
illness, other cancers, sudden death, kidney
disease, sickle cell anemia, thyroid
problems
Social Feels safe at home and work. No Never married, no children. Lived
History history of tobacco use. No one in independently since age 20, currently lives
household smokes. History of with mother and sister in a single family
smoking pot, last time was age 21. home to support family after death of
Drinks alcohol 1-2 times a week, few father one year ago. Employed 32 hours
drinks each time. Baptist religion. per week as a supervisor at Mid-American
