Healthy history family analysis

Health History Form

Relationship: Cousin brother

Gender: Male

Age: 12 years

Date of Birth: 12th October 2006

Date of Death (if applicable): NA

Cause of Death (if applicable): NA

Medical History: Weak eyesight, obesity

Psychiatric History (optional): NA

Behavioral Factors: No exercise, unhealthy eating

Psychosocial Risk Factors: Easy going and friendly