This morning I was reading an article on WND entitled Homeschooler's Neighbor Sparks Social Services Case. The topic of the article aside, I found this fascinating attachment in the comments following the article. It's called Teen Questionnaire, 13 to 18 Years Old:
Apparently this is a Kaiser Permanente insurance form. Because the screenshot is so small, I transcribed the questions as follows:
1. Do you always wear a seatbelt when riding in a car?
2. Do you ever use a bike, scooter, skateboard, skis/snowboard, or rollerblades WITHOUT a helmet?
3. Have you ever had a sunburn?
4. Do you play sports or get at least 60 minutes of active physical play each day?
5. Do you eat five or more servings of vegetables or fruits every day?
6. Do you usually drink more than one soda, juice, or sports drink each day?
7. Do you usually spend more than two hours a day watching TV or movies, playing video games, or using the computer?
8. Are you using supplements (such as creatine, andro, or steroids)?
9. In the past year, have you used laxatives, diet pills, or made yourself vomit to try to lose weight?
10. Have your grades been dropping at school?
11. Are you having any problems at school?
12. Do you, your parents, or any of your friends have a gun?
13. Have you ever been physically abused by an adult?
14. Have you ever been forced or pressured to have sex?
15. Have you ever been in trouble with the law?
16. Are your close friends gang members?
17. Does anyone smoke in your home?
18. Have you smoked cigarettes or chewed tobacco during the past year?
19. Do your close friends drink alcohol or get high?
20. Have you ever been in a car with a driver who had too much to drink or was high?
21. During the past year did you drink any alcohol?
22. Have you ever tried drugs (such as marijuana, cocaine, ecstasy, glue, or meth)?
23. During the past few weeks, have you OFTEN felt sad, down, or hopeless?
24. Have you seriously thought about killing yourself, made a plan, or tried to kill yourself?
25. Who do you live with?
26. Do you feel safe at home?
27. Have you had sex (including oral, vaginal, or anal sex)?
28. Do you sometimes have sexual feelings for someone of your own sex (gay or lesbian feeling)?
29. If you have any other concerns, please write them here.
Here are a couple of comments left after this attachment:
One person writes: This is the form that is given out at the doctor's office. They want the child and the parent to fill out separate forms in order to compare answers. We have refused these questionnaires each time they have been given to us. The receptionist admitted to me when I questioned the form that this for does not affect our insurance or the care my children receive. She said that the doctor wanted the information, but my doctor said that the clinic wanted it. Too much information!
Another person writes: Questions #1, 2, 12, 17 are looking for obedience. Question #20 calls for speculation by an unqualified individual. Questions# 22, 24, 28 can be construed as enticement. Question# 27a is simply asinine
I've never seen such a form from our doctors, but then we don't have Kaiser. Has anyone else seen something like this?