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Chapter 4: Health History Forms
Details
Activity Description
Preparation
- Check the website to ensure it is not blocked at your site.
- Read through the lesson plan.
- Print and make copies of any handouts.
Teacher Tips
This is chapter 4 of a 4-chapter book.
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Program Areas
- ESL: English as a Second Language
Levels
- Beginning Literacy
- Beginning Low
- Beginning High
Lesson Plan
Ask students what forms they complete when they go to the doctor. Ask them if they fill out the forms in English or in their native language. Who helps them fill out the information for the doctor?
Today you will learn how to fill out a health history form. This is a form that the doctor asks you to fill out every year to update your health history.
Review the vocabulary by pointing to the word and pronouncing it. Write a sentence on the board using the word and ask students to write a sentence about themselves.
Some possible sentences are: I have high blood pressure. I don't have high blood pressure. (Students can use this structure for asthma, arthritis, diabetes, and stomach problems.)
I take a lot of medications. I don't take any medications. I take blood pressure medication. etc.
Divide students into breakout rooms or in pairs and have them practice the words in small groups. Have them take the quiz either in pairs or individually.
Present the Personal history form. Review each part.
Part 1: Personal information: Write the following questions on the board:
What is her first name? What is her last name? What is her address? What city does she live in? What state does she live in? What is her zip code? What is her phone number? What is her date of birth? How old is she? What is her gender? (You will need to discuss, prefer not to say. This may be a good time to talk about gender roles that students may not be familiar with.
Have the students practice answering the questions.
Part 2: Emergency information? Ask students who to call in an emergency. Ask the question, What is the emergency contact name? What is the relationship? What is the phone number?
Part 3:Medical Information: Review the information on the form. Discuss surgery and dates.
When students are ready, have them take the quiz in pairs or individually.
Have students get into pairs or breakout rooms and practice asking and answering questions first about Mei Ling and then about themselves.
After students have taken the quiz, if they have a Google account, have them download a copy the health history form to fill out. If not, perhaps you can make a screenshot of the form to print for them to fill out.
Note: Students must take the quiz before trying to fill out the form.
As a further review for students who need more practice. Have them do this reading practice.
Hopefully, students will be able to fill out the most minimal information on a health history form the next time they go to the doctor.
Standards
- Reading Foundational Skills
- RF.2 - Demonstrate understanding of spoken words, syllables, and sounds (phonemes). (Phonological Awareness)
- RF.3 - Know and apply grade-level phonics and word analysis skills in decoding words. (Phonics and Word Recognition)
- RF.4 - Read with sufficient accuracy and fluency to support comprehension. (Fluency)
- Language
- CCR Anchor 1 - Demonstrate command of the conventions of English grammar and usage when writing or speaking.
- CCR Anchor 2 - Demonstrate command of the conventions of English capitalization, punctuation, and spelling when writing.
- CCR Anchor 3 - Apply knowledge of language to understand how language functions in different contexts, to make effective choices for meaning or style, and to comprehend more fully when reading or listening.
- CCR Anchor 4 - Determine or clarify the meaning of unknown and multiple-meaning words and phrases by using context clues, analyzing meaningful word parts, and consulting general and specialized reference materials, as appropriate.
- CCR Anchor 5 - Demonstrate understanding of figurative language, word relationships, and nuances in word meanings.
- CCR Anchor 6 - Acquire and use accurately a range of general academic and domain-specific words and phrases sufficient for reading, writing, speaking, and listening at the college and career readiness level; demonstrate independence in gathering vocabulary knowledge when encountering a word or phrase important to comprehension or expression.
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