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