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A Global Response to Elder Abuse - page 71 / 149

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PAGE 56

OTHER SIGNIFICANT RELATIONSHIP(S)

16. Do you have any other significant relationships? Yes p No p N/A p R/A p

If "No" go to question 18.

Explore the relationship between the subject and the grandchild(ren). If there are any problems, with whom?

Please list relationship:

A:

B:

C:

D:

Describe any problems:

17. Does this person have any specific health problem or emotional problem (include, illness, handicap, alcohol or drug or gambling addiction, or mental illness?

Yes p

No p

N/A p

R/A p

If "Yes", explain:

If "Yes", describe the impact that it has had on you:

Does this person live with you? Yes p No p N/A p R/A p

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