Healthy history family analysis

profileaashna.jain21
SurinderKumarGarg.doc

Health History Form

Relationship: Grandfather (Maternal)

Gender: Male

Age: 73 years

Date of Birth: 15th July 1945

Date of Death (if applicable):NA

Cause of Death (if applicable): NA

Medical History: Cardiovascular disease, 2 bypass surgeries, Diabetes

Psychiatric History (optional): NA

Behavioral Factors: Heavy smoker, heavy alcohol abuse, very active lifestyle, doesn’t really eat healthy

Psychosocial Risk Factors: Worked in army and was boarded out of service due to head injury, always happy, and likes to be around people.