HEMO (M / 14-09-2006)

Initials HEMO
Birthdate 14-09-2006 (9 year(s) old)
Gender Boy
Date for an appointment with the doctor none
Group Coagulation diseases EKZ

This list has been completed by:Mother
What is your date of birth?19-04-1974
What is your marital status?Single
What is the country of birth of your (ex) partner (the father or mother of your child)?The Netherlands
How many children do you have?3
Optional explanation:efwefewf
How many children are currently living with you and how old are they?There is / are 3 child(ren) younger than 4 years old
What is the current work situation for yourself?
(more than one answer possible)
Sick leave
Sports club17-04-2015
Is your child involved in a sports club? (such as soccer, judo, horseback riding)No

It is hard for me to walk more than one blockNeverAlmost never
It is hard for me to runSometimesSometimes
It is hard for me to do sports activity or exerciseAlmost neverOften
It is hard for me to lift something heavySometimesAlmost never
It is hard for me to take a bath or shower by myselfSometimesNever
It is hard for me to do chores around the houseOftenNever
I hurt or acheAlmost neverSometimes
I have low energyAlmost neverAlmost never
I feel afraid or scaredNeverAlmost never
I feel sad or blueAlmost neverAlmost never
I feel angrySometimesSometimes
I have trouble sleepingNeverAlmost never
I worry about what will happen to meNeverAlmost never
I have trouble getting along with other kidsNeverNever
Other kids do not want to be my friendNeverNever
Other kids tease meNeverNever
I cannot do things that other kids my age can doNeverSometimes
It is hard to keep up when I play with other kidsNeverAlmost never
It is hard to pay attention in classNeverNever
I forget thingsNeverNever
I have trouble keeping up with my schoolworkNeverAlmost never
I miss school because of not feeling wellNeverSometimes
I miss school to go to the doctor or hospitalNeverSometimes

This list has been completed by:Mother
Considerate of other people's feelingsSomewhat true
Shares readily with other children (treats, toys, pencils etc.)Somewhat true
Helpful if someone is hurt, upset or feeling illNot true
Kind to younger childrenSomewhat true
Often volunteers to help others (parents, teachers, other children)Somewhat true
Restless, overactive, cannot stay still for longCertainly true
Constantly fidgeting or squirmingNot true
Easily distracted, concentration wandersSomewhat true
Thinks things out before actingSomewhat true
Sees tasks through to the end, good attention spanNot true
Often complains of headaches, stomach-aches or sicknessCertainly true
Many worries, often seems worriedSomewhat true
Often unhappy, down-hearted or tearfulSomewhat true
Nervous or clingy in new situations, easily loses confidenceNot true
Many fears, easily scaredNot true
Often has temper tantrums or hot tempersSomewhat true
Generally obedient, usually does what adults requestCertainly true
Often fights with other children or bullies themNot true
Often lies or cheatsCertainly true
Steals from home, school or elsewhereSomewhat true
Rather solitary, tends to play aloneNot true
Has at least one good friendNot true
Generally liked by other childrenNot true
Picked on or bullied by other childrenNot true
Gets on better with adults than with other childrenSomewhat true
Do you have any other comments or concerns?wefwefwefew
Overall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people?Yes, minor difficulties
How long have these difficulties been present?1-5 months
Do the difficulties upset or distress your child?Only a little
Home lifeNot at all
FriendshipsA great deal
Classroom learningOnly a little
Leisure activitiesA great deal
Do the difficulties put a burden on you or the family as a whole?Only a little

What type of education are you currently in?Regular primary school
In what grade are you?7
Have you ever had to double a grade?No
How many schooldays have you missed in the past three months?5

Is there anything you would like to ask/tell the person with whom you have an appointment?No