Social History: |
Has used tobacco:
Has used alcohol
Currently uses alcohol
History of alcohol abuse?
Has used drugs
Has had legal issues with law enforcement
Currently incarcerated or serving parole, probation, or house arrest
Has had sex with risk of HIV, Hepatitis B, Hepatitis C
Has had male to male sex
Has has sex with a prostitute
Has had sex in exchange for money, drugs, etc.
Has had sex with someone who uses needles for non-prescription drug use
Has used needles for non-prescription drug use
Has been in jail over 72 hours
Has contracted an STD (sexually transmitted disease)
Has been on dialysis
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