FB303_Anamnesebogen

Health department city and district Hof

Online form anamnesis sheet school entrance examination

Welcome to the online form for the school entry examination of the city and district of Hof!

The school entrance examination is an aid for you and your children to detect health impairments relevant for school attendance, such as visual, hearing or speech disorders. A review of fine motor skills is also conducted, as this is an important prerequisite for learning to write.

Completion of the following medical history form is voluntary and serves to better prepare for the respective individual case as well as anonymous data collection for the Bavarian State Office for Health and Food Safety.

Sprachauswahl / select language

german | english

Personal data of the legal parent(s)

status of family member*

salutation

title

surname*

name*

street*

house number*

postalcode*

city*

E-Mail*

phone*

Are there any other persons who are entitled to raise the child?*

Details of the other parent/guardian

status of family member

salutation

title

surname*

name*

residence of the parent/guardian

street*

house number*

postalcode*

city*

Personal data of child

For a clear and error-free assignment, please use the data from your childs invitation letter.

surname*

name*

birthday*

place of birth*

street*

house number*

postalcode*

city*

nationality

number of sisters/ srothers

number of adults in household

native language father

nursery/ KITA/kindergarten attendance (type of facility)

nursery/ KITA/kindergarten attendance in years

Parents details

Child Data

Pregnancy, birth and development

Diseases of child

Support measures and treatments