fitness-self assessment e1

7/28/2019 Fitness-Self Assessment E1

1/15

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


2/15

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


3/15

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


4/15

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.

?

[email protected]

lf-Assessment" whiling writing to us.


5/15

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


6/15

##### ##### ##### ##### #####

##### ##### ##### ##### #####

itely.


7/15


8/15


9/15


10/15


11/15


12/15


13/15

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


14/15

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!







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


15/15

Marks Marks Marks Marks

Date Date Date Date

8 9 10

#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

fitness-self assessment e1

Documents