Health History and Screening of an Adolescent or Young Adult Client

Student Name:ANKUR SHALI Date: February 02, 2013
Biographical Data
Patient/Client Initials: A.S. Phone No: 7089546543
Address: 3249 Polly lane, Berwyn, Illinois.
Birth Date:01/16/1988 Age:25 Sex:Female
Birthplace: Illinois Marital Status: Married
Race/Ethnic Origin: Hindu Indian
Occupation: Nursing Employer: Rush University Medical Center, Chicago, Illinois.
Financial Status: Patient has a great lifestyle. Patient has Blue Cross HMO from Employer and she is financially self-sufficient.

Source and Reliability of Informant: The Informant is the patient. She has had no history of dementia or forgetfulness. She is alert and oriented to person, place and time.

Past Use of Health Care System and Health Seeking Behaviors: Patient was previously admitted in 2005 for nausea/ vomiting due to food poisoning. Apart from that hospitalization, patient says she only visits the hospital for checkups.

Present Health or History of Present Illness: Patient said she has been vomiting for 3 days and that she cannot keep anything down. She said she is in her early weeks of pregnancy.

Past Health History
General Health: “I feel terrible and tired because of this vomiting”

Allergies: (include food and medication allergies)
No known drug allergies, no known food allergies Reaction:

Not applicable
Current Medications:

Takes Tylenol 325mg 2 tablets occasionally for headaches, Self-prescribed Prenatal Vitamins, Dulcolax at night for occasional constipation
Last Exam Date: had last check up with her primary doctor in November 2012 for physicals pertaining to employment. Immunizations: Patient said she completed all her childhood immunizations. Took the influenza shot in October 2012.

Childhood