Child & Adolescent Behavioral Health Information

Please correct the errors described below.

4. Pediatric Symptom Checklist (c 1988, MS Jellinek & JM Murphy, Massachusetts General Hospital) Emotional and physical health go together in children. Because parents are often the first to notice a problem with their child's behavior, emotions or learning, you may help your child get the best care possible by answering these questions. Please Mark under the heading that best fits your child.

For the following questions, please indicate a

  • 0 Never
  • 1 Sometimes
  • 2 Often

5. Over the last 4 weeks, how often has your child been bothered by any of the following problems? For the following issues, please use the following scale.

  • 0 Not at all
  • 1 Several Days
  • 2 More than Half the Days
  • 3 Nearly Every Day

MEDICAL & PHYSICAL HISTORY

PREVIOUS BEHAVIORAL HEALTH TREATMENT

OTHER

FAMILY HISTORY

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