Cultural Considerations Assessment
General Information
Name
Date
Assessor
Cultural Background
Ethnicity/Cultural Identity
Country of Origin
Primary Language(s) Spoken
Other Relevant Cultural Factors
Religious/Spiritual Beliefs
Religion/Spiritual Practice
Important Beliefs or Practices
Family and Social Dynamics
Family Structure
Key Social Supports
Community Role/Status
Communication
Preferred Communication Style
Interpreter Required?
Yes
No
Other Considerations
Health Beliefs and Practices
Traditional Remedies or Healers
Beliefs Affecting Care
Dietary/Special Needs
Additional Notes