How to fill in the questionnaire of students' mental health in Zhucheng East Road School

Instructions for filling in the form

1. The margins on the top, bottom, left and right sides of this form are all 1.5cm, and the parts to be filled in the registration form are all Song Woods, so it is not necessary to be bold. If there are many cells, you can reduce the font size.

2. Other departments need to fill in the full name of the department and affix the seal of the department.

3. Insert the electronic photo directly into the photo paste, with the format of width× height: 2.6cm×3.6cm, the way of surrounding the text is "floating above the text", and the cell is placed in the center. If there is no electronic photo, there is no need to attach it.

4. Basic information of students and families: All information is in the middle except the column of specific family situation. If there are too many contents to fill in, and one line cannot be displayed completely, you can reduce the font size appropriately to ensure that the form remains unchanged.

5. The date and date of birth of the form should be filled in Arabic numerals, such as 20XX, x, x, XX.

6. Grade filling format: 20 1X grade.

7. The full name should be filled in the column of specialty.

8. Classes should fill in Arabic numerals, such as: class 1, without professional name.

9. Family history and students' past medical history should include physical illness history and psychological illness history.

10. column of specific family situation: fill in paragraph by paragraph, with two words in the first line, with a spacing of 28 points between lines and scattered alignment. Pay attention to the use of punctuation. Content: Introduce parents' physical and marital status, family economic status and other conditions that may affect students' psychological state in detail.

1 1. categories of psychological problems: according to the actual situation of students, the contents should conform to eleven categories in the Reference Standard for Students' Psychological Problems, including: psychological test problems, family medical history problems, stress events, academic problems, family economic problems, personal psychological illness history and personal psychological illness history. (Note: The content of this column should be consistent with the column of "Problem Category" in the summary table. Please refer to the "Reference Standards for Students with Emphasis on Psychological Problems" for judging criteria. )

12. Severity of psychological problems: according to the students' situation, fill in the categories in the Reference Standard for Severity of Students' Psychological Problems, including "general psychological problems", "serious psychological problems" and "neurotic psychological problems"

Topic: Suspected psychosis, neurosis (diagnosed as depression), neurosis (diagnosed as anxiety), neurosis (diagnosed as others) and psychosis. (Note: The content in this column should be consistent with the column of "Severity" in the summary table. For details, please refer to the Reference Standard for the Severity of Students' Psychological Problems. )

13. Specific questions: fill in the form of paragraphs, with two words in the first line, with a spacing of 28 points, scattered and aligned, and pay attention to the use of punctuation marks. The content should be detailed, explaining the time when the students' problems were discovered and the situation at that time, explaining the specific performance of the students' situation and the reasons for the problems they learned. If the student is diagnosed with neurosis or mental illness, please indicate the time and place when he was diagnosed.

14. Measures taken: Write down what intervention measures have been taken after finding the situation, what effects have been achieved, what intervention methods will be taken in the future, and whether the mental health education center is needed to intervene. Counselors need to print the form and sign it in the corresponding position.

15. Department handling opinions: filled in and signed by the department secretary, indicating whether the situation has been understood and whether it is agreed to report.

16. The contents of this form need to be printed on one page. If there are many contents, you can adjust the line spacing appropriately to display all the contents on one page. If there is less content, you can appropriately increase blank lines to ensure beautiful page layout.