Term
| How far did you go in school? |
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Definition
| What languages do you speak? |
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Term
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Definition
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Term
| What type of home do you have? |
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Definition
| What do you do for a living? |
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Term
| What other jobs have you had? |
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Definition
| Have you ever been in the military? |
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Term
| Do you feel any of your jobs have had hazards or risks to your health? |
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Definition
| Do you have any financial concerns about your home? Food? Health Care? |
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Term
How much alcohol do you drink? what type? how much? how often? how long have you been using this?
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Definition
a. have you ever felt you should CUT down your drnking?
b. have people ANNOYED you by criticizing your drinking?
c. have you ever felt bad or GUILTY about your drinking?
d. have you EVER had a drink first thing in the morning to steady your nerves or get rid of a hangover? |
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Term
| Do you use any tobacco products? what type? how much? how often? how long have you been using this? |
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Definition
| Do you use any other recreational drugs? what type? how much? how often? how long have you been using this? |
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Term
| have you been sexually active in the past? |
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Definition
| Are you currently sexually active? |
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Term
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Definition
| Do you follow a special diet? If yes; What is it? |
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Term
| What do you do for leisure or to relax? |
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Definition
| What do you do for physical activity or exercise? |
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Term
| How often or for how long do you do that? (quantify each activity) |
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Definition
| Do you feel safe in your relationship? Has anyone physically hurt you? Insulted you? Threaten you with bodily harm? Screamed at you? |
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Term
| Do you have someone to help you if you are physically ill or emotionally upset? Who would that be? |
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Definition
| How does religion and spirituality influence your health care? |
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Term
| Do you regularly wear a seat belt? |
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Definition
| Do you regularly use sun screen? |
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Term
| Do you have a smoke detector? |
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Definition
| Do you have any weapons in the house? |
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Term
| Do you have a living will? |
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Definition
| Have you designated someone to make healthcare decisions for you if you are |
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