Environmental History for J.S.

This family occupies the third floor of a three-flat. Their water supply comes from city water piped in from a local lake. All food is bought at a grocery store, with the execption of occasional fresh tomatoes from the landlady in the summer. There are no unusual hobbies. This is a single-parent family. The mother works as a secretary. The patient and his brother are in high school, they do not have part-time jobs. The family has no pets.

Questions addressed to patient:

1.Do you live next to or near an industrial plant, commercial business, dump site,
or nonresidential property? No

2. Which of the following do you have in your home? Please circle all that apply.

    Air Conditioner Air Purifier Central Heating (gas or oil)
    Gas Stove Electric Stove Fireplace
    Wood Stove Humidifier  

3. Have you recently acquired new furniture or carpet, refinished furniture or No
remodeled your home?

4. Have you weatherized your home recently? No

5. Are pesticides or herbicides (bug or week killers, flea and tick sprays, collars, powders, or shampoos) used in your home or garden or on pets? No

6. Do you (or any household member) have a hobby or a craft? Yes

7. Do you work on your car? Yes

8. Have you ever changed your residence because of a health problem? No

9. Does your drinking water come from a private well, city water supply,
or grocery store? City water supply

10. Approximately what year was your home built? 1920

If you answered yes to any of the questions, please explain.

6. My brother and I are rebuilding a 1973 VW Beetle we bought for $800.

7. My mom likes to make beaded jewelry. About two weeks ago my friend brought over a jar of liquid mercury so my mom could clean some silver beads she was making into a necklace.


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