Healthy history family analysis

Health History Form

Relationship: Father

Gender: Male

Age: 47 years

Date of Birth: 9th April 1971

Date of Death (if applicable): NA

Cause of Death (if applicable): NA

Medical History: Diabetes, Hypertension, Obesity

Psychiatric History (optional): NA

Behavioral Factors: Smoking, Alcohol abuse, poor diet and no exercise

Psychosocial Risk Factors: Was raised in a nurturing environment, loss of productivity, increased absenteeism