Refer to the Milestone 1: Health History guidelines and grading rubric found on the Week 1: Milestone 1 Assignment page. This assignment is worth 225 points. Clarity of writing is worth 20 of the 225 points.

Chamberlain College of Nursing NR305 Health Assessment

Course Project Milestone #1: Health History Form

For Use July 18

Your Name: Date:

Your Instructor’s Name:

Directions : Refer to the Milestone 1: Health History guidelines and grading rubric found on the Week 1: Milestone 1 Assignment page. This assignment is worth 225 points. Clarity of writing is worth 20 of the 225 points.

Type your answers on this form. Click Save as and save the file with the assignment name and your last name, for example, NR305_Milestone1_Form_Smith. When you are finished, submit the form by the deadline by using the Submit button on the assignment page. Post questions in the Q & A Forum or contact your instructor if you have questions about this assignment.

Disclaimer The focus of this assignment is on communicating details within the written client record. When taking a health history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do not need to disclose information that they wish to keep confidential. If the interviewee decides not to share information, please write, “Does not want to disclose.” If the client fails to disclose answers to several items, you will need to find another client who is willing to share.

Note: Completing this assignment on yourself will result in a 20% penalty deduction being applied.

BIOGRAPHICAL DATA (15 points)
Date:
Initials:
Age:
Date of birth:
Birthplace:
Gender:
Marital status:
Race:
Religion:
Occupation:
Health insurance:
Source of information:
Reliability of source of information:
PRESENT HEALTH HISTORY/ILLNESS (20 points)
Reason for seeking care:
Health patterns:
Health goals:
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