Диссертация (1174235), страница 21
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˗Vol. 12 ˗ Р.33.143ПРИЛОЖЕНИЯПриложение А (справочное)Типовая карта опросника САНФамилия, инициалы _______________ Пол __ ВозрастДата ___________ Время _______123456789101112131415161718192021222324252627282930Самочувствие хорошееЧувствую себя сильнымПассивныйМалоподвижныйВеселыйХорошее настроениеРаботоспособныйПолный силМедлительныйБездеятельныйСчастливыйЖизнерадостныйНапряженныйЗдоровыйБезучастныйРавнодушныйВосторженныйРадостныйОтдохнувшийСвежийСонливыйЖелание отдохнутьСпокойныйОптимистичныйВыносливыйБодрыйСоображать трудноРассеянныйПолный надеждДовольный321012332101233210123321012332101233210123321012332101233210123321012332101233210123321012332101233210123321012332101233210123321012332101233210123321012332101233210123321012332101233210123321012332101233210123Самочувствие плохоеЧувствую себя слабымАктивныйПодвижныйГрустныйПлохое настроениеРазбитыйОбессиленныйБыстрыйДеятельныйНесчастныйМрачныйРасслабленныйБольнойУвлеченныйВзволнованныйУнылыйПечальныйУсталыйИзнуренныйВозбужденныйЖелание работатьОзабоченныйПессимистичныйУтомляемыйВялыйСоображать легкоВнимательныйРазочарованныйНедовольный144Приложение Б (справочное)Типовая карта опросника SF˗36Ф.
И. О._______________________________________Дата заполнения________________1. В целом Вы бы оценили состояние Вашего здоровья (обведите одну цифру)Отличное.......................................................................... 1Очень хорошее ............................................................... 2Хорошее ...........................................................................
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