Personal Health Inventory

Life Style Inventory

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Disposition. Exceptionally good natured, easygoing (-3); average (0); extremely tense and nervous most of the time (+6)    
Exercise. Physically active employment or sedentary job with well-planned exercise program (-12); sedentary with moderate regular exercise (0); sedentary work, no exercise program (+12)    
Home environment. Usually pleasant, better than average family life (-6); average (0), unusual tension, family strife common (+9)    
Job satisfaction.  Above average (-3); average (0); discontented (+6)    
Exposure to air pollution.  Substantial (+9)    
Smoking habits.  Non-smoker (-6); occasional (0); moderate, regular smoking 20 cigarettes, 5 cigars, or 5 pipefuls (+12); heavy smoking 40 or more cigarettes daily (+24); marijuana frequent (+24)    
Alcohol habits.  None or seldom (-6); moderate with less than 2 beers or 8 ounces of wine or 2 ounces of whiskey or hard liquor daily (-12 � if you consider current research, +6 if you follow this older chart); heavy, with more than above (+24)    
Eating habits.  Drink skim or low-fat milk only (-3), eat much bulky food (-3), heavy (3 times a day) meat eater (+6); more than 2 pats of butter daily (+6); more than 4 cups coffee/tea/cola daily (+6); usually add salt at table (+6 but is in dispute).    
Auto driving. Regularly less than 20,000 miles annually, and always wear seat belt (-3), regularly less than 20,000 but not always seat belt (0), more than 20,000 miles (+12)    
Drug habits. Use of street drugs (+36)    
TOTALS � Part one    

 

Physical Inventory

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Weight.  �Ideal� weight at age 20 was ______. If current weight is more than 20 pounds over that, score (+6) for each 20 pounds. If same as at age 20 , or less gain than 10 pounds (-3)    
Blood pressure.  Under 40 years, if above 130/80 (+12); over 40 years, if above 140/90 (+12).    
Cholesterol. Under 40 years, if above 220 (+6); over 40 years, if above 250 (+6)    
Heart murmur.  Not an �innocent� type (+24); with history of rheumatic fever (+48)    
Pneumonia.  If bacterial pneumonia more than three times in life (+6)    
Asthma (+6)    
Rectal polyps  (+6)    
Diabetes.  Adult-onset type (+18)    
Depressions.  Severe, frequent (+12)    
Regular* medical checkup.  Complete (-12), partial (-6).
* Regular refers to healthy people who have thorough medical exams at the following frequencies, according to age: 60 and up, every year, 50 � 60 every 2 years, 40 � 50, every three years, 30 � 40, every 5 years, 25 � 30, as required for jobs, military, etc.
   
Regular dental checkup.  Twice yearly (-3)    
TOTALS � Part Two    

 

Family and Social Inventory

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Father. If alive and over 68 years, for each 5 years above 68 (-3); if alive and under 68 or dead after 68 (0); if dead of medical causes (not accidental) before 68 (+3).    
Mother. If alive and over 73 years, for each 5 years above 73 (-3); if alive and under 68 or dead after 68 (0); if dead of medical causes (not accidental) before 73 (+3).    
Marital Status.If married (0); unmarried and over 40 (+6).    
Home location. Large city (+6), suburb (0), farm or small town (-3).    
TOTALS � Part 3    

 

For Women Only

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Family history of breast cancer. In mother or sisters (+6)    
Examines breasts monthly (-6)    
Yearly breast exam by physician (-6)    
Pap smear yearly (-6)    
TOTALS � Part 4    

 

Score

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  –

TOTALS � Part 1    
TOTALS � Part 2    
TOTALS � Part 3    
TOTALS � Part 4    
TOTAL � Chart    
Current age    
Divide chart total by 12 and enter with + or – .    
Add or subtract the above figure from your current age for your MEDICAL AGE.    

 

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