utilized for   the second assignment in Topic 3.

Develop an interview questionnaire to be used in a family-focused   functional assessment. The questionnaire must include three   open-ended, family-focused questions to assess functional health   patterns for each of the following:

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1. Values/Health Perception
2. Nutrition
3. Sleep/Rest
4. Elimination
5. Activity/Exercise
6. Cognitive
7. Sensory-Perception
8. Self-Perception
9. Role Relationship
10. Sexuality
11. Coping