Fill out this section if there is any changes to your client's physical health.  Select the answer corresponding to your client's current situation and indicate the date of the change. 

Client states he/she is in good physical health?

Client has access to needed medical services?

      -This question asks if the client has the means to get medical services or whether they have medical insurance.

Client receives needed medical Services?

      -This question asks whether the client actually go to see his/her doctor.

Client has a primary care physician?

Client uses a primary care physician?

Client has access to needed dental services?

      -This question asks if the client has the means to get dental services or whether they have dental insurance.

Client receives needed dental services?

      -This question asks whether the client actually go to see his/her dentist.

Is client obese (based on BMI)?

Has client ever been told by a physician that he/she has diabetes?

      -Record Type I or type II only, not gestational diabetes.

Circle *YES*, *NO*, or *UNKNOWN* for the following two statements:

Did client receive physical health services from a DHS clinic or hospital in the past 12 months?

Department of Health Services (DHS) has published a list of their clinics if you're not sure...Harbor/UCLA is an example of a DHS (or County) Hospital).

List of DHS clinics

Does the client have a chronic physical health care problem or problems that require periodic medical services?

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