Social history

SOCIAL HISTORY
Accommodation:
[-] lives alone
[-] lives with partner
[-] lives with family
[-] lives in share accommodation
[-] lives in hostel
[-] no permanent home

Smoking:
[-] never smoked
[-] current smoker
[-] ex-smoker
  If smoker, pack-year history:

Alcohol intake:
[-] nil
[-] alcohol use
  If yes, standard drinks per week:

Exercise:
[-] regular exercise
  If yes:
  Type: 
  Frequency:

Diet:
[-] omnivorous
[-] vegetarian
[-] vegan
[-] pescatarian
[-] gluten-free
[-] lactose-free
[-] low FODMAP

Occupational history:
  Current employment: 
  Occupation: 
  Employer: 
  Date started:

Previous employment (if relevant): 
  Occupation: 
  Years: 
  Occupation: 
  Years:

Educational history:
  Highest level of education: 
  Discipline/s:

Social contact: (hours per week)
  Online social interaction (telephone/video calls): 
  Screen time: 
  Social media use: 
  Sport/physical/recreational activities:

Services and care received:
-

Patient or carer's social concerns:
-

Social history

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