Family Medicine & Community Health 3

Family Oriented Medical Record

Arnel Herrera, MD | 11 September 2018
○ Family roles with regards to health
OUTLINE: ○ Family wellness plan
I. MEDICAL RECORD ● Records should be simple, complete, clear, and efficient
II. CONCEPT OF FOMR
A. Basic parts o FOMR A. BASIC PARTS OF FOMR
1. Summary of socio – demographic data of  Summary of socio-demographic data of nuclear family
nuclear family members members
2. Family assessment tool and family wellness
 Family assessment tools and family wellness plan
plan
a. Genogram  Consultation records of each family members
b. Family APGAR
c. Family Map 1. Summary of socio – demographic data of nuclear family
d. Family health beliefs interview members
st
e. Family wellness plan  Front page of the FOMR (Advantage: 1 glance will give
3. Consultation records of each family the family physician an idea who among the family
members members will have a ff up or has a disease like
III. KEEPING TRACK OF QUALITY MEDICAL RECORDS hypertension, DM)
IV. ELECTRONIC RECORDS AND PRIVACY
 Includes information about the nuclear family of the
CONFIDENTIALITY ISSUES SURROUNDING FOMR
patient and/or others sharing the household with the
patient for a long period of time
I. MEDICAL RECORD
 The composition of the family, health problem they
● The cornerstone of a good clinical practice and accurate encounter, reasons for visits, and follow-up care plan
documentation is a good medical record  Updates done on an annual basis
● It includes the account of patients’ signs and symptoms,
assessment and diagnostics, and treatments received 2. Family assessment tool and family wellness plan
● Ensures the continuity of quality medical care and  These are two integral parts of the FOMR
effective communication with other health care providers  Unique feature of a family physician practice because the
● Used also for medico-legal purposes (for our protection) family physician is able to see the interrelatedness of
● Bases for 3rd party payers health and illness
○ HMO: Health Maintenance Organization  The problem is: the completion can take more than one
● Used for effective teaching and research tools (Chart and visit (usually 3-4 visits before completion)
records are used to teach interns, clerks and residents  Family assessment tool – Genogram, APGAR, Family map,
especially for data in research) Family health beliefs
● Can provide evidence of care that patient has received
● Documentation increases the effectivity for follow through 2.1 Genogram
care and data for assessment of practice  Provides graphical representation of illnesses
● Included in medical records is the pharmacologic and non  Identify the different health care roles of the family members
pharmacologic management of the patient assume once a family member got sick
 Important roles to be identified
Before, POMR (Problem Oriented Medical Record) is utilized but o Breadwinner/financer
family physicians improved a more comprehensive record, the FOMR o Caregiver/alternate caregiver - Important if the illness
because in POMR, the data incudes only the individual / patient. In
is chronic or if the patient is bedridden
care giving, the mother usually takes care of the sick but if the
mother is not around, any significant others will take care of the o Index patient
patient that’s why family is considered as an ally for the treatment of o Decision maker - Identify If the breadwinner /
the patient, therefore, making the family oriented medical record. caregiver is not the breadwinner
o Family doctor
II. CONCEPT OF FAMILY ORIENTED MEDICAL RECORD (FOMR)  Genogram Example
● Should extend beyond filing of the individual records of o Should be 3 generations
nuclear family members and include o There is a legend.
○ Common tools of family assessment  Do not include legends of male/female as
■ Genogram well as the bonds, and ‘living together’
■ APGAR (these legends are universal and are
○ Health beliefs of the family

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Family Medicine & Community Health 3
Family Oriented Medical Record
understood by the physician). Also do not 2.3 Family map
include the ‘dead’ legend.  Determines stability of family relationship
 Important are for diseases. No universal  What’s the meaning of those lines?
legends for these.  Family APGAR and Family Map usually Aids the family
o Index patient, breadwinner or caregiver are missing in physician to gauge how family members will take care of
the example the sick member of the family who’ll take care of the sick
 If the APGAR score is dysfunctional and if the Family map
shows Problematic relationship, then doctor is warned
that there will be problem in care-giving
 Example
a. Child: APGAR is 2, family map is problematic
relationship - refer to DSWD
b. Adult/Geriatric - refer to other sectors of society,
because there will be problems

2.2 Family APGAR

 Adaptation, partnership, growth, affect, resolve
 Assess degree of family planning
o Important if you want to evaluate how the family
members will take care of the sick family
2.4 Family health beliefs interview
member
 Cultural beliefs or biases that affect health seeking and
o Can have as many family members as you want,
health maintenance behaviour
just take the average
 Help address the family’s desired treatment goals
o Scoring
 Responses in the questions below should be included in
 0-3 severely dysfunctional
the FOMR
 4-6 moderately dysfunctional
a. Do they belong to an ethnic or religious group
 7-10 highly functional
with distinct health practices?
o No blood transfusion - Jehovah’s
b. What is the patients and family’s explanation for
the illness?
c. Will they be open to non-conventional
therapies?
d. What are the treatment goals and preferences
for therapeutic approaches?

2.5 Family wellness plan

 Important things that should be included:
a. What screening tests should be requested?
b. If there were any immunizations done?
c. Any lifestyle changes/counselling?
 Family physician practice because they see
interrelatedness between health and illness
 Problem is completion can take more than one visit

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Family Oriented Medical Record
 Anything that is checked or included in the Review of
Systems should not be included in the history of present
illness and anything that is included or related to the
history of present illness should not be included here in
the ROS
 Past Medical History should not be part of History of
Present Illness
 Example of common mistake:
a. The problem is HTN and DM, and yet still
included in PMH; should not be included
because it is an on-going problem even if
3. Consultation records of each family members
diagnosed 10 years ago. From the start in
1. Front sheet containing summarized problem list and
management History, label the patient Hypertensive or
2. Record of initial consult Diabetic and indicate if controlled or not.
3. Record of subsequent consult in a SOAP (subjective,
objective, assessment, plan) format

3.1. Front sheet containing summarized problems list and

management
 Gives physician birds eye view of family health problems
 Saves time on going through the individual records

3.3. Record of a subsequent consult in SOAP format – Follow up

patient record
 S - Subjective
o Chief Complaint
o History of Present Illness
 C - Psychosocial Context of the disease
3.2. Record of initial consult o Example: Child complaining of abdominal pain; in
 Date of Consult and History history, mother has anxiety disorder because she
 Should be included: is in the midst of trial separation from her
a. History of Present Illness husband.
b. Review of Systems o Psychosocial Context: Child is using the illness to
c. Past Medical History gain attention from the parents. Pag may sakit
d. Personal/Social History siya, laging magkasama yung parents niya hoping
e. Obstetric/Menstrual History (females only) that they will patch-up things.
f. Birth/Maternal History, Developmental  O - Objective
Milestones, and Immunization History (pediatric o Vital Signs
patients) o Clinical Exam
g. Physical Examination o Laboratory Results - requested during the initial
h. Assessment Plan consult
o Diagnostic and therapeutic test for  A - Assessment
treatment o Should be current
o Follow-up o Based on history and physical examination
o Referral findings, not previous diagnosis of previous
 Should not be included: consultation
a. Family History - included in the genogram

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Family Oriented Medical Record
o Example: Patient is already diagnosed as
hypertensive 3 years ago; you still need to put it III. KEEPING TRACK OF QUALITY MEDICAL RECORDS
in the present assessment. State the present ● Are the records easy to retrieve?
situation of HTN: controlled or uncontrolled. ○ Individual patient files should be identifiable
 Uncontrolled – indicate stage – JNC 7/8 within the family record.
 Controlled – by medications or lifestyle ○ Illness and treatments should be easily accessed
changes same with the lab results.
 P – Plan of Management ● Are the records legible?
o Diagnostics (any lab work-ups) ○ Write legibly.
o Therapeutics (any medicines prescribed) ● Are the records arranged chronologically?
o Supportive treatment (non-pharmacologic) ○ How? Arrange from the most recent to the
o Any Advice oldest. Most recent should be on top.
o Referrals ● Do the records also keep track not only of curative but also
o Date of follow-up preventive services for the patient and the family?
○ Health teachings should be also included.
FOOLLOW-UP PATIENT RECORD (FPR) ○ Advice and health education given to the
patient.
● * At present, we are currently using papers, but in some
institutions, they are already using electronic records
(other countries).

IV. ELECTRONIC RECORDS AND PRIVACY CONFIDENTIALITY ISSUES

SURROUNDING FOMR
● Cost effective for it eliminates the need for paper based
system and helps facilitate communication among staff
members.
○ Initial investment
■ Software for electronic records – very
expensive
○ Staff training
■ Efficient implementation
● RA 10173 (DATA PRIVACY ACT) entitled “an act protecting
individual personal information in the information and
communication systems in the government and the private
sector, crating for this purpose a national privacy
commission, and for other purposes” classified health
records as sensitive personal information
● Most important is the privacy and confidentiality of the
patient and the family.

REFERENCES
1. Lecture recording and ppt or Dr Hererra

 Again, the FOMR can be modified based on the demand of

practice. It can be fit to purpose.

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