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DATE OF BIRTH *Note: Please provide information for Infants and Toddlers (marked *) as appropriate to the age of your child. DEVELOPMENTAL HISTORY Age began sitting crawling walking talking *Does your child pull up? *crawl? *walk with support? Any speech difficulties? Special words to describe needs Language spoken at home:.
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Dispensing FAQ
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Social History (SH): An age appropriate review of the patient's past and current activities which may include significant information about: Marital status and/or living arrangements. Current employment. Occupational history. Use of drugs, alcohol or tobacco. Level of education. Sexual history. Other relevant social factors.
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History, developmental: An account of how and when a person met developmental milestones, such as walking and talking. For adults, information on social-emotional development may be included. Used primarily in the diagnosis of developmental disorders.
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Social History: Patient feels safe and well-cared for in his home. He works as an electrician, a job with daily physical exertion that requires climbing ladders and the lifting of heavy objects. These aspects of his job have been impacted with his lightheadedness and muscle pain and weakness.
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Father's Name: ... Please describe the mother's general health during the pregnancy: ... How old was the mother when the child was born? ... What was your child's weight at birth? ... At what age did your child sit up? ... Do you suspect your child used drugs or alcohol?
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Social history is a broad category of the patient's medical history but may include the patients smoking or other tobacco use, alcohol and drug history and should also include other aspects of the patient's health including spiritual, mental, relationship status, occupation, hobbies, and sexual activity or pertinent ...
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The Social History Template is a 7- or 8-item questionnaire that addresses needs in 3 domains (economic stability, neighborhood/physical environment, and food). Identifying and treating a substandard housing cluster using a medical-legal partnership.
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The purpose of the social history is to obtain information about the student that extends beyond the school environment. The social history report contains interpersonal, familial, emotional, behavioral, academic, and environmental variables that influence the student's adaptation to school.
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It provides information on any developmental delays, health and psychological issues, behavioral concerns, and family and cultural factors that may contribute to the child's learning problems. The history also provides information on the strengths your child may have.
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