1. Family composition.
Type of family, age, gender and racial/ethnic composition of the family.
2. Roles of each family member. Who is the leader in the family? Who is the primary provider? Is there any other provider?
3. Do family members have any existing physical or psychological conditions that are affecting family function?
4. Home (physical condition) and external environment; living situation (this must include financial information). How the family support itself.
For example; working parents, children or any other member
5. How adequately have individual family members accomplished age-appropriate developmental tasks?
6. Do individual family member’s developmental states create stress in the family?
7. What developmental stage is the family in? How well has the family achieve the task of this and previous developmental stages?
8. Any family history of genetic predisposition to disease?
9. Immunization status of the family?
10. Any child or adolescent experiencing problems
11. Hospital admission of any family member and how it is handle by the other members?
12. What are the typical modes of family communication? It is affective? Why?
13. How are decision make in the family?
14. Is there evidence of violence within the family? What forms of discipline are use?
15. How well the family deals with crisis?
16. What cultural and religious factors influence the family health and social status?
17. What are the family goals?
18. Identify any external or internal sources of support that are available?
19. Is there evidence of role conflict? Role overload?
20. Does the family have an emergency plan to deal with family crisis, disasters?
