WebHealth assessment questions may be asked about patients of all ages, including children and adolescents. Some common health assessment questions ask about: Tobacco use. Stress. Healthy eating. Physical activity. Sexual practices. Sedentary behaviors such as sitting and watching TV or playing computer games. Alcohol usage. WebThis list of brief health assessment questions is organized by behavior or risk and sorted alphabetically. 4-7 In some cases, you can choose one of two options (A or B, not both). Questions marked with are suitable for the Centers for Medicare & Medicaid Services (CMS) Annual Wellness Visit (AWV) health risk assessment.

Staying Healthy Assessment

WebStaying Healthy Assessment 12 – 17 Years DHCS 7098 G (Rev 12/14) SHA (12 – 17 Years) Page 1 of 2 Name (first & last) Date of Birth ... Yes No Please answer all the questions on this form as best you can. Circle “Skip” if you do not know an answer or do not wish to answer. Be sure to talk to the doctor if you have questions about ... WebStaying Healthy Assessment Adult Patient’s Name (first & last) Date of Birth Female Male Today’s Date Person Completing Form (if patient needs help) Family Member Friend Other … driving school lasalle montreal

Staying Healthy Assessment FAQs - Partnership …

WebStaying Healthy Assessment. FAX-IN ORDER FORM. To: Central California Alliance for Health From: _____ Printing Services PCP: _____ ... 7098E Assessment questionnaire (goldenrod) 18+ English 7098E SP Assessment questionnaire “ 18+ Spanish 8098A Patient handout (pink) 0-3 English 8098A SP Patient handout “ 0-3 Spanish ... WebUSING THE STAYING HEALTHY ASSESSMENT The Staying Healthy Assessment is an age‐appropriate questionnaire designed to be self‐administered by the patient or parent. … http://www.sfhp.org/wp-content/files/providers/forms/SHA_PowerPoint.ppsx driving school langley bc