Family study Pro-forma Sathish Chandra MR 1 , Sharankumar Holyachi 2 , Veena V 1 Introduction Family study discussion is one of the integral parts of Post-graduate teaching. It helps the Post-graduate to have a comprehensive understanding regarding the dynamics in a family, and how each of these has a bearing on the health and disease states of the family members. Having gone through the process of family study presentation during the post-graduation, the authors felt that available family study formats (1,2) were either in- complete or were filled with lot of ambiguities or grey areas. Hence a need for an elaborate format was felt, which can be accepted or can have consensus statement from majority of the Community Medicine Depart- ments. The authors accept that this pro-forma still remains incomplete. Hence all the Community Health Profes- sionals from various institutes are requested to send in your suggestions, modifications, comments and criti- cisms so that a single standard pro-forma can be put in use. The present publication is an attempt towards collecting all possible details to be included in the pro-forma. Based on suggestions received from all the faculty and other stakeholders the authors intend to bring out the addendums required to fill the pro-forma in the next issue of the journal. A. Area map Important landmark, approach roads and health care facilities. Type of road to approach the house: mud/ cement/ tar/ others Appropriate roads and position of house in relation to adjacent dwelling. B. General information 1. Name of the locality: 2. Name of the PHC/ UFWC: 3. Name of local governing body: 4. Major occupation in the area 5. Name of the head of family/ responsible adult respondent: 6. Name of the person interviewed: 7. His/her relation to the Head of the family: 8. Duration of stay at this address: 9. Address: Taluk: District: Contact no: Series 1 Assistant Professor, Department of Community Medicine, BGS Global Institute of Medical Sciences, Bangalore. 2 Assistant Professor, Department of Community Medicine, SS Institute of Medical Sciences & Research Centre, Davangere. Correspondence to Dr Sathish Chandra MR ([email protected]) The layout of the journal has been changed for this article facilitating better readability and understanding. The editorial team along with the authors request the readers to kindly send improvements, suggestions, queries to the editorial e-mail id and all at- tempts will be made to answer/incorporate them. The subsequent parts will include explanations to each parts and replies of the author/editorial team for various comments received. ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014 | Page: 63
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Family study Pro-forma Sathish Chandra MR1, Sharankumar Holyachi2, Veena V1
Introduction
Family study discussion is one of the integral parts of Post-graduate teaching. It helps the Post-graduate to
have a comprehensive understanding regarding the dynamics in a family, and how each of these has a bearing
on the health and disease states of the family members. Having gone through the process of family study
presentation during the post-graduation, the authors felt that available family study formats(1,2) were either in-
complete or were filled with lot of ambiguities or grey areas. Hence a need for an elaborate format was felt,
which can be accepted or can have consensus statement from majority of the Community Medicine Depart-
ments.
The authors accept that this pro-forma still remains incomplete. Hence all the Community Health Profes-
sionals from various institutes are requested to send in your suggestions, modifications, comments and criti-
cisms so that a single standard pro-forma can be put in use. The present publication is an attempt towards
collecting all possible details to be included in the pro-forma. Based on suggestions received from all the faculty
and other stakeholders the authors intend to bring out the addendums required to fill the pro-forma in the next
issue of the journal.
A. Area map
Important landmark, approach roads and health care facilities.
Type of road to approach the house: mud/ cement/ tar/ others
Appropriate roads and position of house in relation to adjacent dwelling.
B. General information
1. Name of the locality: 2. Name of the PHC/ UFWC:
3. Name of local governing body: 4. Major occupation in the area
5. Name of the head of family/ responsible adult respondent:
6. Name of the person interviewed:
7. His/her relation to the Head of the family: 8. Duration of stay at this address:
9. Address:
Taluk: District: Contact no:
Series
1Assistant Professor, Department of Community Medicine, BGS Global Institute of Medical Sciences, Bangalore. 2Assistant Professor, Department of Community Medicine, SS Institute of Medical Sciences & Research Centre, Davangere. Correspondence to Dr Sathish Chandra MR ([email protected]) The layout of the journal has been changed for this article facilitating better readability and understanding. The editorial team along with the authors request the readers to kindly send improvements, suggestions, queries to the editorial e-mail id and all at-tempts will be made to answer/incorporate them. The subsequent parts will include explanations to each parts and replies of the author/editorial team for various comments received.
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014 | Page: 63
64 ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
10. Religion: Hindu /Muslim/ Christian/ Others
11. Caste: General/ OBC/ SC/ ST/ Others
12. Card holders: BPL/APL
13. Type of family: Nuclear/ Joint/ 3-generation 14. Number of family members:
Males: Females: No of married couples:
Sl.
No
Nam
e
Rel
atio
n t
o
Hea
d o
f
Fam
ily
a
Ag
e
Sex
b
Mar
ital
Sta
tusc
Ed
uca
tio
nd
Occ
up
atio
n
Inco
me
Per
-an
nu
m
Rem
ark
s/
Co
mm
ents
1
2
3
4
5
Total
a) Relationship to HoF: Self=1, Wife=2, Son=3, Daughter=4, Son/daughter in law=5, Grandchildren =6,
Mother in law /Father in law=7, Father=8, Mother=9, Others =10
b) Sex: Male=1, Female= 2
c) Single =1, Married =2, Widowed =3, Separated/ Divorced =4