General Survey Form Objective: Conduct a General

General Survey Form Objective: Conduct a General survey on a person of your choice. The purpose of this interaction isobservation only. 1. Physical Appearance/Hygiene: a. General appearance:b. Genderc. Apparent aged. Ethnic groupe. Appears overall healthyf. Well-groomed or disheveled (Note the general color of skin and hygiene) 2. Body Structure and Movement (Observe general stature): a. Height appropriate for apparent ageb. Appears well nourishedc. Weight suitable for the heightd. Position or posture (comfortable and relaxed) e. Obvious deformitiesf. Walks with ease g. Gait balanced and smoothh. Limitations to range of motion. Involuntary movements j. Using assistive devices 3. Emotional/Mental Status and Behavior: Level of alertness Appear well rested or tired Converse appropriately Behavior appropriate for the situation Dress suitable for the weather 4. Document observations with detailed responses in a narrative format. For example, if aclient appears tired provide a description adequate for the reader to visualize the client,”Client is alert and appears tired, slumped in a chair with eyes half closed.” 5. Describe two actual or potential risk factors for the client based on the assessmentfindings with description or reason for selection of them

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