Fitness-Self Assessment E1
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Transcript of Fitness-Self Assessment E1
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Prabhune's Ask yourself these simple question
Health Self-Assessment - E Fill the Choice Number(1, 2 or3) of
HEALTH & FITNESS - See your Marks. Assess your Health
SELF ASSESSMENT QUESTIONNAIRE Choice Choice
. Question No No.
1 2
1 Is my Appetite good? No _ _
2 How do I feel after usual meal? Satisfaction Dissatisfaction
3 Have I a problem while passing stools? No _ _
4 Have I a problem while passing urine? No _ _
5 Is there Oedema over my body (face/Legs)? No
6 Do I Sleep well? No _ _
7 Stories I can climb without stopping? One Two
8How do I look in a mirror?
9 Distance I can blow out the candle? One Foot Two Foot
10 Numbers I can count (one number pre
second) without stopping to breathe?More than 20 More than 30
11 Part of leg I can touch while bending forward
(without bending the Knees)?Knee Shin
12 Can I get up from sitting position without
support?Yes Somehow
13 Organs of Body demanding attention? Zero One
14 My Pulse-rate is within - 60-75 75-90
15Am I Anemic? Yes/Dont Know Under Treatment
16Am I Hypertensive? Yes/Dont Know In Control
17Am I Diabetic? Yes/Dont Know In Control
18 My usual reaction to Extra work? Yes O.K.
19 My usual reaction to New work? Yes O.K.
20Am I Enthusiastic at the end of the day? Yes Sometimes
21 My usual Reaction when something goes
wrong?OK. What is wrong?
Anger/Others are
responsible
22 How do I feel after Day's Work? Satisfaction Dissatisfaction
23Am I Comfortable with people?
Yes/Sometimes/wit
h someReluctantly
24Do people like me?
Yes/Sometimes
/Some peopleNo
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25Do I feel like doing something for others?
Yes/Sometimes
/For SomeReluctantly
Total Marks
Health & Fitness - Self AssessMarks: -25 to -11 Serious Problem I should attend my
Marks: -10 to -1 Bad Health I should attend my
Marks: 0 to 10 Not Good Timely attention to
Marks: 11 to 20 Health Generally enough. B
Marks: 21 to 25 Good Health Continuous and Lif
Self-Health Evaluation
For Category wise 1) In which category have I low marks?Elaborate Health Evaluation 2) from that, I will know areas of Health-Fi
See page 2. 3) Accordingly, I will be able to take Docto
4) I will do repeated Health-Fitness Reass
Sakar Manahshanti Kendra After how many days? - After 3, 6 or
Dr. Prabhune Hospital 5) Where can I contact forFurther Advic
e-mail Address: rajendraprabh
Please mention "Health & Fitness S
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sincerely. Sakar Manahshanti Kendra - Dr. Prabhune Ho
Your answer, in Correct Cell, in "Choice No. (Ch. No.)" Column.
by compairing them with marks in "Self Assessment Chart" below this questionna
Choice
Ch.
No. Marks
Ch.
No. Marks
Ch.
No. Marks
Ch.
No. Marks
Ch.
No. Marks
No
3
Yes ##### ##### ##### ##### #####
Fullness/Nausia ##### ##### ##### ##### #####
Yes ##### ##### ##### ##### #####
Yes ##### ##### ##### ##### #####
Yes ##### ##### ##### ##### #####
Yes##### ##### ##### ##### #####
Three ##### ##### ##### ##### #####
##### ##### ##### ##### #####
Three Feet ##### ##### ##### ##### #####
More than 40##### ##### ##### ##### #####
Ankle##### ##### ##### ##### #####
No##### ##### ##### ##### #####
Two-Three ##### ##### ##### ##### #####
> 90 or < 60 ##### ##### ##### ##### #####
No ##### ##### ##### ##### #####
No ##### ##### ##### ##### #####
No ##### ##### ##### ##### #####
No ##### ##### ##### ##### #####
No ##### ##### ##### ##### #####
No ##### ##### ##### ##### #####
Dissatisfaction##### ##### ##### ##### #####
Guilt / Anger ##### ##### ##### ##### #####
No##### ##### ##### ##### #####
Dont Know##### ##### ##### ##### #####
5 - Date1 - Date 2 - Date 3 - Date 4 - Date
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No##### ##### ##### ##### #####
##### ##### ##### ##### #####
ent Chartealth as an imergency. I will do to a Doctor immeditely.
ealth. I have to go to a Doctor.
ealth is necessary. I have to do more Efforts. Preferably with Doctor's advice. I will start Imme
t I have to continue Efforts to Maintain health and to Increase fitness.
long Efforts are necessary to maintain ealth. I will always remember this.
ness Improvement.
r's Advice and to do Efforts.
essment to Evaluate Improvement after doing guided efforts.
12 Months according to the need.
?
lf-Assessment" whiling writing to us.
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pital
ire.
Ch.
No. Marks
Ch.
No. Marks
Ch.
No. Marks
Ch.
No. Marks
Ch.
No. Marks
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### ########## ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### ########## ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
##### ##### ##### ##### #####
10 - Date8 - Date 9 - Date6 - Date 7 - Date
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##### ##### ##### ##### #####
##### ##### ##### ##### #####
itely.
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HEALTH & FITNESS -
SELF ASSESSMENT Catego
Category wise Marks Marks Marks
Health Date Date
Category 1 2 3
1 Physical Health #VALUE! #VALUE!2 Psychological Health #VALUE! #VALUE!
3 Social Health #VALUE! #VALUE!
4 Heart & Vascular System #VALUE! #VALUE!
5 Respiratory System #VALUE! #VALUE!
6 Digestive System #VALUE! #VALUE!
7 Excretory System #VALUE! #VALUE!
8 Musculo-Skeletal System #VALUE! #VALUE!
Total #VALUE! #VALUE!
Health Evaluation Graph
According to
Category Wise Marks-6 -5
Catego
ry
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-5.0
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
1
2
3
4
5
6
7
8
Health
Catego
ry
Health Analysis -
1 & 2
Series1 Series2
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ry Wise Health Evaluation
Marks Marks Marks Marks
Date Date Date Date
4 5 6 7
#VALUE! #VALUE! #VALUE! #VALUE!#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
1
2
3
4
5
6
7
8
Health
Catego
ry
Health Analysis -
5 & 6
Series1 Series2
-6 -5
Catego
ry
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-4 -3 -2 -1 0 1 2 3 4 5 6
1
2
3
4
5
6
7
8
Health
Health Analysis -
3 & 4
Series1 Series2
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Marks Marks Marks Marks
Date Date Date Date
8 9 10
#VALUE! #VALUE! #VALUE! #VALUE!#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
#VALUE! #VALUE! #VALUE! #VALUE!
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-4 -3 -2 -1 0 1 2 3 4 5 6
1
2
3
4
5
6
7
8
Health
Health Analysis -
7 & 8
Series1 Series2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
1
2
3
4
5
6
7
8
Health
Catego
ry
Health Analysis -
9 & 10
Series1 Series2