Huoltajan Ilmoitus Oppilaan Terveydestä, 5. Luokka

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Huoltajan Ilmoitus Oppilaan Terveydestä, 5. Luokka

Tekoul-82.doc 4.6.2012 2. 2. 1. confidential,it and benotdisclosed will parties to third the by departmenthealth care yourwithout consent. informationreturnand it soon as as possibletoschool thenurse. Theinformation with supplied formisthe Regardinghealththe inspection of 5 4. 4. friendships attendance and School and School Student HealthCare routines 3. Health School Family Health Health Name of Name guardiantheof Name guardiantheof ofNative language child the Home address and theLast offirst names child thatDo you yourthink ishealthy? child alcoholIs other or intoxicants used family?in your theresmokersAre family?in your does childHowyour spend freetime?their does familyHowyour spendtogether? time sleeping Child’s duration eating specialChild’shabits,etc. diets, child Has your experienced bullyingschool?at muchyour How beenhas absentchild school? from child Does youreducation receive special other / support school?at child Does yourrequirewith assistance homework? much day Howper do time spendthey on completing homework? isyourHow doing child school?at Persons householdliving samein the as childthe th grade pupils,we request you fillthat this out with form child’s your Guardian formGuardian HEALTH SURVEY AND 5 th GRADEWELL-BEING PUPIL Language spoken homeat daily time Child’sscreenvideo computer, (TV, consoles, gameetc.) family together?Does youreat child others?Does yourbully Phone number Phone number Personalnumber identity 1 (2) Tekoul-82.doc 4.6.2012 development 5. 8. 8. 7. family pupil and the situationthe of 6. Thank you! Thank and School Student HealthCare School nurseSchool Signature Current Puberty and Have discussionsHave you withinhad family thepuberty-relatedabout matters? physical (Mood, changes, etc.)friendships, child Has your received any Suchas rehabilitation?speech therapy, therapy,occupational physical etc.therapy, Medication nameneeds, medicationof child from Does yoursuffer any long term diseases? Who fortheiris responsible treatment? child Does your experience headaches,recurring stomach pain, sleeping difficulties, allergicbedwetting,reactions? phone Name numberand and Placetime career.child’sschoolyourDoyou have any to matters related family’shealthyour and well-beingyou wish discuss? to thereareSometimes changes that childthethe mustgo and through, family and changesthosemay significance bear successfulnessthetoof feeldo What you you have been successful in? theare What of strengths family?your child is yourWhat good at? Have you uponagreedcurfew child?your with times Guardian formGuardian HEALTH SURVEY AND 5 th GRADEWELL-BEING PUPIL Do you know where child your spends free time?their Guardian’ssignature 2 (2)

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