Fill - Free fillable (Pediatric ACEs and Relevant Life Events Screener) (PEARLS) (ACEs Aware) PDF form

Hindi 2020

  

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(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – (Child)

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 

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   

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   

PTSD

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    

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   

 

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    

  

        



                

      

   

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            

          



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  



 

     

Child (Parent/Caregiver Report) - Deidentified

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       

 

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     



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      

  

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         



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 

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 



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 

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 

Child (Parent/Caregiver Report) - Deidentified

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Hindi 2020

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  

(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – (Child)

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 िलए

 



  



  

    

        

      



          

 

 

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1

कपया जहां लाग हो "हां" पर X का िनशान लगाएं

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 



☐☐



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   

☐



☐



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  

 PTSD

☐☐

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    

☐☐



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  

  

☐☐

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    

 

☐☐

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    

   





☐☐



            

      

      

☐

☐



            

          

 

☐☐



  



☐☐



     

Child (Parent/Caregiver Report) - Identified

ृ ू ।



2

कपया जहां लाग हो "हां" पर X का िनशान लगाएं



       

 

☐☐



    

 

☐☐



      

  

☐☐



         



☐☐



 

☐☐





 







☐







☐





 



☐☐



 

Child (Parent/Caregiver Report) - Identified



Hindi 2020

ृ ू

।

Hindi 2020



  

(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – 

(Teen Caregiver Report)



 िलए

 



  

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  

    

        

      



          

 

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1

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 

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   

   

PTSD

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    

  

 

    

 

       



               

      

    

            

          



  



 

  

Teen (Parent/Caregiver Report) - Deidentified



2



       

 

     



      

  

        



 

 



 



     

          

 

Teen (Parent/Caregiver Report) - Deidentified



Hindi 2020



  

(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – 

(Teen Caregiver Report)



 िलए

 



  



  

    

         

      



          

 



1

कपया जहां लाग हो "हां" पर X का िनशान लगाए।ं





 





☐



☐

   

☐☐



  

 PTSD



☐☐

    



☐



☐

 

  

☐☐

    

 

☐

☐

    

   

☐☐

            

         

   



☐☐

            

          



☐☐

  



☐

☐



     

Teen (Parent/Caregiver Report) - Identified

ृ ू



2

कपया जहां लाग हो "हां" पर X का िनशान लगाए।ं



       

  

☐☐

    

 

☐

☐

      

  

☐☐

         



☐

☐

 



☐



☐

 





☐



☐

 





☐



☐

     



☐



☐

              



☐



☐



Teen (Parent/Caregiver Report) - Identified

Hindi 2020

ृ ू

Hindi 2020





(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – (Teen (Self Report))

 





  



 

  

    

    

  

     

 



1



 





   

PTSD





    

 

  



 



         

   





       

    

    



दसरे अनुभाग के “हाँ” वाले उतर जोड़ै:

  

Teen (Self Report) - Deidentified



2



    

 

  



   

  

       



 

  



 



  

           

 

Teen (Self Report) - Deidentified



Hindi 2020





(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – (Teen (Self Report))

 





  



 

  

     

       

     





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1 X 



 

 

☐☐







☐



☐

   

PTSD



☐☐





☐



☐

   

  

 

☐☐

 

  

☐

☐

 



☐☐

         

   



☐☐

       

   



☐☐

    



☐☐



     

Teen (Self Report) - Identified



2

X  



    

 

☐☐

 

 

☐☐

   

  

☐☐

       



☐☐

 



☐



☐

  





☐



☐

 





☐



☐

  



☐



☐

           



☐



☐



Teen

(Self Report) - Identified



Hindi 2020

  



(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – (Child)



  िलए

 



  



  



तनावपूण

   

        

       



          

 

उतर



 



1





 





   



   

PTSD





    



   

 

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    

  

        



                

      

   



            

          





  



 

     

Child (Parent/Caregiver Report) - Deidentified

'



2

कपया जहां लाग हो "हां" पर X का िनशान लगाए



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       

 

☐☐



    

 

☐☐

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      

  

☐☐

          



☐☐



 



☐







☐



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 

 

☐☐



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 

 

☐







☐



 

Child (Parent/Caregiver Report) - Identified



Hindi 2020

ृ ू ं।

Hindi 2020



  

(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – 

(Teen Caregiver Report)

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 िलए

 



  



  

    

        

      



          

 



1



 



   

   

PTSD



    

  

 

    

 

       



               

      

    

            

          



  





  

Teen (Parent/Caregiver Report) - Deidentified





2 कपया जहां लाग हो "हां" पर X का ਿनशान लगाए।ं 



       

  

☐☐

    

 

☐

☐

      

  

☐☐

         



☐

☐

 



☐



☐

 





☐



☐

 





☐



☐

     



☐



☐

              



☐



☐



Teen (Parent/Caregiver Report) - Identified

Hindi 2020

ृ ू

Hindi 2020





(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – (Teen (Self Report))

 





  



 

  

    

    



     

 



1



 





   

PTSD





    

 

  



 



         

   



       

    

    





  

Teen (Self Report) – Deidentified

2

X  



    

 

☐☐

 

नरल,



 

☐

☐

   

  

☐☐

       



☐

☐

 



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

☐

  



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

☐

 





☐



☐

  



☐



☐

           



☐



☐



Teen

(Self Report) - Identified



Hindi 2020

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