Demographics |
Age; Gender; Race/Ethnicity; Residence; Education; Marital Status; Employment; Income Level; Insurance |
10 |
Vitals/Labs |
Weight; Height; (Body-Mass Index); Waist Circumference; Lipid Panel; Blood Pressure; Glycosilated Hemoglobin (HbA1c) |
11 |
Behavioral Health |
Dietary Habits; Physical Activity; Tobacco Use; Alcohol Use; Drug Use |
22 |
Environmental Health |
Stress/Anxiety; Hazardous Materials; Outdoors Risks; Crime Rate; Violence/Abuse; Unemployment |
14 |
Self Health History |
35 Leading Chronic Conditions and Their Varieties |
47 |
Family Health History |
16 Leading Hereditary Risk Factors (1st and 2nd Degrees) |
16 |
Healthcare Utilization |
Outpatient Visits; Hospitalizations/Nursing Home Admissions; Emergency Department Visits; Major Surgeries |
4 |
Allergies & Misc. Risks or Risk Modifiers |
Immune Compromise; Vitamin Deficiency; Egg Allergy; G-globulin; Varicella; Guillain-Barre; Organ Removal |
10 |
Personal Safety |
Sun Protection; Car-Related Risks; Risky Sports; Fire/Smoke Alarm; Pool Safety; Motor Cycle; Firearms |
15 |
Sexual Health |
Menses; Sexual Activity; Pregnancy; Menopause; Birth Control; Hormon Replacement Therapy; Fertility; Sexually Trans. Disease |
16 |
Mental Health |
Depression/Anxiety; Mental/Cognitive Activity; Suicide; Trauma; (PHQ-9 test triggered by a positive PHQ-2 test) |
16 |
Preventive Services |
Preventive Services History Related To 15 Preventable Or Modifiable Health Conditions |
23 |
Health-Related Quality of Life & Personal Goals |
Self-Rated Overall Health; Self-Rated Quality of Life; Refusal Of or Concern With Care; Meaningful Life Activities |
11 |