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NWTS-5 FAMILY QUESTIONNAIRE A. PATIENT DATA Patient name: Social Security #: — Patient ID#: Birth date: / / mm Birth weight: lbs oz dd by birthplace: B. PARENT DATA Natural father Natural mother
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How to fill out nwts-5 family questionnaire

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How to fill out NWTS-5 Family Questionnaire:

01
Start by carefully reading the instructions provided along with the questionnaire. Understand the purpose and significance of each section.
02
Provide accurate and complete information about your family, including names, ages, and relationships of all family members.
03
Fill in the demographics section, which includes details about your household's income, education, and employment status.
04
Answer the questions related to housing and living conditions, such as the type of accommodation, access to clean water and sanitation facilities, and the presence of any health hazards.
05
Provide information about the health status of each family member, including any existing medical conditions, disabilities, or chronic illnesses.
06
Complete the section on access to healthcare services, including details about health insurance coverage, healthcare facilities visited, and any challenges faced in accessing healthcare.
07
Answer the questions regarding your family's health behaviors and lifestyle, such as diet, exercise, and tobacco or alcohol consumption.
08
If applicable, provide details about any past or ongoing medical treatment received by a family member.
09
Ensure that the questionnaire is filled out accurately, honestly, and to the best of your knowledge.
10
Sign and date the completed questionnaire.

Who needs NWTS-5 Family Questionnaire?

01
Families who are part of the Northwestern Trauma Survey (NWTS) research study may be required to fill out the NWTS-5 Family Questionnaire.
02
The questionnaire aims to collect information about the health, living conditions, and healthcare access of participating families.
03
It allows researchers to assess the impact of trauma on families and provide valuable insights for developing interventions and policies related to trauma-informed care.
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The nwts-5 family questionnaire is a questionnaire used to gather information about a family's financial situation and background.
The head of the household or the primary income earner is required to file the nwts-5 family questionnaire.
The nwts-5 family questionnaire can be filled out online or on paper, and it requires detailed information about income, expenses, assets, and liabilities.
The purpose of the nwts-5 family questionnaire is to assess a family's financial need and determine eligibility for financial assistance programs.
Information such as income, expenses, assets, liabilities, family members, and housing situation must be reported on the nwts-5 family questionnaire.
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