Uraian
Permasalahan
Kondisi fisik klien
(kesehatan, usia,
kebiasaan sehaihari klien)
Kebiasaan belajar
klien di rumah
3.
Pergaulan/hubung
an sosial dengan
anggota keluarga
- dengan orang
tua
- saudara
(adik/kakak)
4.
Pergaulan/hubung
an sosial dengan
tetangga dan
teman sebayanya.
Upaya keluarga
memotivasi belajar
klien
5.
6.
Dukungan
keluarga terhadap
belajar klien
:
:
:
:
Jawaban Responden /
Keterangan
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Mengetahui,
Kepala Sekolah
Zuzainah, S. Pd.
NIP. 19620601 198903 2 002