GENERAL HEALTH PROFILING FOR SCHOOL NON TEACHING

Following Structure of Porfiling is Recommended to be followed:

Name of Institution : GOVT. GIRLS HIGHER SECONDARY SCHOOL FAZILPUR DISTRICT RAJANPUR

Name of District : RAJANPUR

Part (A)
Basic Medical History (To be Filled by Non Teaching Staff
Non TeachingBio Data:

Name of Teacher Age Gender Residential Address

Part (B)
History (To be Filled by Teacher and Verified by Recognized Medical Professional (RMP)

Family History of any Medical Past Medical and Surgical

or Psychiatric Illness History, if any

Part (C)
General Physical Examination (To be Filled by Paramedic Staff)
 Any Obvious
Overall General Physical Structural
Height Weight Blood Pressure Temperature Pulse Rate Respiratory Rate
Health on Appearance abnormality
on Inspection
ILING FOR SCHOOL NON TEACHING

Photo

Designation Contact #

History of Substance Decreased Appetite and

abuse in Family Loss of Weight
Any Superficial Cuts, Needle Marks
or Burn Marks on Arm
Part (D)
1 General Mental Health (To be Filled by Psychiatrist):
General Appearance and Behavior Especially Understanding of Situation and
Self-Care, Rapport Building. and Instruct

2 General Mental Health (To be Filled & Authenticated by Concerned Institution)

Manifestat
on of risky Social
behaviors media
e.g post/other
increased History of Keeping bad
History of pointers of Increased Lack of
frequency Stealing, Late company/fri Decline in Disturbed
Past Smoking A decline in of vehicle Habit of Abrupt interest frequency Physical
coming in ends with other sleep-wake
Psychiatric and any Running change in towards of mood energy and
Academic accidents, away/Bunking classes habits of actvites of Cycle/habit
History, other Daily substance/d swings or motvaton
substance / Performance school
frequent routne Classes involvement bullying interest/ho Routne of dozing in
If any rug use e.g increased easy
fight in Sexual using drugs bbies the Classes
drugabuse tattoos, irritability fatgability
keeping Actvites or fights stckers on
some vehicle
weapons /book etc.
like Knife
etc.

1 2 3 4 5 6 7 8 9 10 11 12 13

Part (E)
 (Is applicable in case of Positive intial Risk Assessment)
1 Structured / Formal Psychological Assessment:

Proceed to this or Referal for this only if there is increased risk of Substance use Suspected o
the basis of above mentioned Geneal Health Profile

2 Urine Drug Screening Test :

Employ this for Confirmation if Formal Psychological Assessment Confirms the Suspecious o
Substance use found on Screening by General Health Profiling
Understanding of Situation and Response to Questions
and Instructions.

Evidance of
remains of
Un-usual Cigarettes/o
Un-Usual Protectve
behaviors/b ther objects
Suspiciousn of use,
Decline in ess or any eing over- employed
Decline in in
other un- Socializaton secretve
Self-Care usual/unex taking
behavior drugs,
plainable regarding inside
behaviors personal his/her
belongings personal
belongings

14 15 16 17 18
ere is increased risk of Substance use Suspected on
entioned Geneal Health Profile

chological Assessment Confirms the Suspecious of

creening by General Health Profiling