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Social history form template

Social history form template 2025

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The document is a confidential social history form for the Glens Falls City School District, designed to collect comprehensive information about a student's family background, health, development, personality traits, school history, and any significant family events or challenges. It aims to assist in understanding the child's needs and developing appropriate educational programs.

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Versions	Form popularity	Fillable & printable
2018	4.9 Satisfied (59 Votes)
2005	4.6 Satisfied (38 Votes)

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What is a social history form?

In medicine, a social history (abbreviated SocHx) is a portion of the medical history (and thus the admission note) addressing familial, occupational, and recreational aspects of the patients personal life that have the potential to be clinically significant.

What is considered social in history?

Social History: Patient is a high school graduate, working as an electrician, living with his wife of 25 years and 2 dogs. Patient feels safe and well-cared for in his home. He works as an electrician, a job with daily physical exertion that requires climbing ladders and the lifting of heavy objects.

What should I put for social history?

The Social history section on the patient Summary contains data elements including, tobacco use, alcohol use, financial resources, education, physical activity, stress, social isolation and connection, and exposure to violence.

What do you write in social history?

First, social history emphasizes large numbers of people in the past, rather than just elites or leading individuals. Common categories include social classes, Gender, Race and ethnic group, and age.

What to write in social history?

Contents 4.1 Historical demography. 4.2 African-American history. 4.3 Ethnic history. 4.4 Labor history. 4.5 Womens history. 4.6 Gender history. 4.7 History of the family. 4.8 History of education.

What are 6 components of a social history?

Social History (SH): An age appropriate review of the patients past and current activities which may include significant information about: Marital status and/or living arrangements. Current employment. Occupational history. Use of drugs, alcohol or tobacco. Level of education. Sexual history. Other relevant social factors.

Social history form template 2025

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