Family Assessment Tool CHN 1 2022 2023
Family Assessment Tool CHN 1 2022 2023
Family Assessment Tool CHN 1 2022 2023
I. DEMOGRAPHIC DATA
Household number:
1. FAMILY DATA
a. Length of residency:
b. Husband’s place of origin:
c. Wife’s place of origin:
2. FAMILY MEMBER’S CHART
Family members Civil Position in Relationship to Educational
Age Sex Occupation
status the family family head Attainment
1
2
3
4
5
6
7
8
9
10
1 Nuclear
2 Extended
3 Matriarchal
4 Patriarchal
5 Dominant family member
6 Others (indicate type of family)
Example:
Single parent family
Childless family
Step family
Grandparent family
negative positive
2. Mother
3. Children
X. ENVIRONMENT
1. Environment
a) Kind of neighborhood