文档介绍：儿童情况调查表
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the king water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
①健全( ) ②智力缺陷( )
③狂躁、抑郁、精神分裂( )说明
④神经官能症( ) ⑤癫痫( ) ⑥脾气乖僻( )
⑦酗酒( ) ⑧***( ) ⑨其他( )说明：
(5)居住情况：
①与子女同住( )②不常同住( ) ③不同住( )
(6)个性特点：
①外向( ) ②中间( ) ③内向( )
(7)嗜烟：①是( ) ②否( )说明：
嗜酒：①是( ) ②否( )说明：
(8)与子女关系：
①亲热( ) ②一般( ) ③疏远( ) ④不融洽( )
2．母亲情况
姓名： 年龄： 工作单位：
(1)文化：
①文盲( ) ②半文盲( ) ③小学( )
④初中( ) ⑤高中( ) ⑥中专( )
⑦大专( ) ⑧大学( ) ⑨大学以上(
(2)职业(专业或工种)：
①科技人员( ) ②行政人员( ) ③文教工作( )
④医务工作( ) ⑤商业工作( ) ⑥军人( )
⑦社会效劳工作( ) ⑧企事业工人( )
⑨农林牧渔劳动( ) ⑩个体经营( )
待业( ) 退休( )
其他( ) 说明：
(3)身体情况：
①健康( ) ②一般( ) ③有病( )说明：
(4)精神状态：
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
①健全( )②智力缺陷( )
③狂躁、抑郁、精神分裂( )说明：
④神经官能症( ) ⑤癫