Lab 1 Medical

Health Medical


American Public Univerity

Question Description

For lab 1, please download this form Health History Questionnaire.

Please have an individual of your choice fill it out (If no one else is around you can do it on yourself as well). You are to then write a lab report on the Health History Questionnaire.

The report should consist of the following sections:

  • introduction
  • methodology
  • results
  • conclusion

The introduction should be a minimum of 2 paragraphs and should use a minimum of 2 peer reviewed sources. The methodology should include how the Health History Questionnaire was administered and a copy of the completed Health History Questionnaire. Share the results of the questionnaire in the results section. Finally, the conclusion section will include what you conclude from these results. Please make sure that the conclusion section is not simply a duplication of the results and instead summarizes the major take-home messages from the entire assignment.

Unformatted Attachment Preview

Health/Medical Questionnaire Date: _________________________ Name: _____________________________ Date of birth: ______________ Soc. Sec. #: __________________ Address: _______________________________________________________________________________________ Street City State Zip Phone (H): ____________________ (W): ____________________ E-mail address: __________________________ In case of emergency, whom may we contact? Name: ______________________________________ Relationship: _____________________________________ Phone (H): ________________________________________ (W): _______________________________________ Personal physician Name: __________________________________ Phone: ____________________ Fax: ____________________ Present/Past History Have you had OR do you presently have any of the following conditions? (Check if yes.) ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Rheumatic fever Recent operation Edema (swelling of ankles) High blood pressure Injury to back or knees Low blood pressure Seizures Lung disease Heart attack Fainting or dizziness with or without physical exertion Diabetes High cholesterol Orthopnea (the need to sit up to breathe comfortably) or paroxysmal (sudden, unexpected attack) nocturnal dyspnea (shortness of breath at night) Shortness of breath at rest or with mild exertion Chest pains Palpitations or tachycardia (unusually strong or rapid heartbeat) Intermittent claudication (calf cramping) Pain, discomfort in the chest, neck, jaw, arms, or other areas with or without physical exertion Known heart murmur Unusual fatigue or shortness of breath with usual activities Temporary loss of visual acuity or speech, or short-term numbness or weakness in one side, arm, or leg of your body Other Family History Have any of your first-degree relatives (parent, sibling, or child) experienced the following conditions? (Check if yes.) In addition, please identify at what age the condition occurred. ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Heart arrhythmia Heart attack Heart operation Congenital heart disease Premature death before age 50 Significant disability secondary to a heart condition Marfan syndrome High blood pressure High cholesterol Diabetes Other major illness _________________________ From NSCA, 2012, NSCA’s essentials of personal training, 2nd ed., J. Coburn and M. Malek (eds.), (Champaign, IL: Human Kinetics). Explain checked items: __________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Activity History 1. How were you referred to this program? (Please be specific.)____________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 2. Why are you enrolling in this program? (Please be specific.) ______________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 3. Are you presently employed? Yes ___ No ___ 4. What is your present occupational position? __________________________________________________ 5. Name of company: ________________________________________________________________________ 6. Have you ever worked with a personal trainer before? Yes ___ No ___ 7. Date of your last physical examination performed by a physician: 8. Do you participate in a regular exercise program at this time? Yes ___ No ___ If yes, briefly describe: ________________________________________________________________________________________ ________________________________________________________________________________________ 9. Can you currently walk 4 miles briskly without fatigue? Yes ___ No ___ 10. Have you ever performed resistance training exercises in the past? Yes ___ No ___ 11. Do you have injuries (bone or muscle disabilities) that may interfere with exercising? Yes ___ No ___ If yes, briefly describe: ______________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 12. Do you smoke? Yes ___ No ___ If yes, how much per day and what was your age when you started? Amount per day ______ Age ______ 13. What is your body weight now? ____ What was it one year ago? ____ At age 21? ____ 14. Do you follow or have you recently followed any specific dietary intake plan, and in general how do you feel about your nutritional habits? ___________________________________________________________ ________________________________________________________________________________________ 15. List the medications you are presently taking. _________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 16. List in order your personal health and fitness objectives. a. ______________________________________________________________________________________ ______________________________________________________________________________________ b. ______________________________________________________________________________________ ______________________________________________________________________________________ c. ______________________________________________________________________________________ ______________________________________________________________________________________ From NSCA, 2012, NSCA’s essentials of personal training, 2nd ed., J. Coburn and M. Malek (eds.), (Champaign, IL: Human Kinetics). ...
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