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<div align="center" style="color: rgb(0, 0, 0); font-family: 'Trebuchet MS'; line-height: 20pt;"><a name="OLE_LINK1" style="color: rgb(102, 102, 102); font-weight: bold;"><span style="font-size: 18pt;">澎湖縣馬公國中 學年度認輔教師輔導個案諮商晤談記錄表</span></a></div><div style="color: rgb(0, 0, 0); font-family: 'Trebuchet MS'; line-height: 20pt;"> </div><div align="right" style="color: rgb(0, 0, 0); font-family: 'Trebuchet MS'; line-height: 20pt;"><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">日期： 年 月 日</span></div> <table border="1" cellpadding="0" cellspacing="0" style="width: 539.4pt; border-collapse: collapse; border-spacing: 0px; color: rgb(0, 0, 0); font-family: 'Trebuchet MS'; line-height: 26.6666641235352px; border: medium none;" width="719"><tbody><tr><td style="padding: 0cm 5.4pt; border: 1pt solid windowtext; vertical-align: top; width: 92pt; background-color: transparent;" valign="top" width="123"><div style="line-height: 20pt;"><span style="font-size: 14pt;">個案姓名</span></div> </td> <td style="padding: 0cm 5.4pt; border-top-width: 1pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: windowtext windowtext windowtext rgb(236, 233, 216); border-right-style: solid; border-top-style: solid; width: 103.5pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="138"><div style="line-height: 20pt;"> </div> </td> <td style="padding: 0cm 5.4pt; border-top-width: 1pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: windowtext windowtext windowtext rgb(236, 233, 216); border-right-style: solid; border-top-style: solid; width: 85.95pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="115"><div style="line-height: 20pt;"><span style="font-size: 14pt;">性別</span></div> </td> <td style="padding: 0cm 5.4pt; border-top-width: 1pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: windowtext windowtext windowtext rgb(236, 233, 216); border-right-style: solid; border-top-style: solid; width: 85.95pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="115"><div style="line-height: 20pt;"><span style="font-size: 14pt;">□男 □女</span></div> </td> <td style="padding: 0cm 5.4pt; border-top-width: 1pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: windowtext windowtext windowtext rgb(236, 233, 216); border-right-style: solid; border-top-style: solid; width: 86pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="115"><div style="line-height: 20pt;"><span style="font-size: 14pt;">班級</span></div> </td> <td style="padding: 0cm 5.4pt; border-top-width: 1pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: windowtext windowtext windowtext rgb(236, 233, 216); border-right-style: solid; border-top-style: solid; width: 86pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="115"><div style="line-height: 20pt;"><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">年 班</span></div> </td> </tr><tr><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 92pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="123"><div style="line-height: 20pt;"><span style="font-size: 14pt;">生日</span></div> </td> <td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 103.5pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="138"><div style="line-height: 20pt;"><span style="font-size: 14pt;"> </span><span style="font-size: 14pt;">年 月 日</span></div> </td> <td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 85.95pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="115"><div style="line-height: 20pt;"><span style="font-size: 14pt;">身分證字號</span></div> </td> <td colspan="3" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 257.95pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="344"><div style="line-height: 20pt;"> </div> </td> </tr><tr><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 92pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="123"><div style="line-height: 20pt;"><span style="font-size: 14pt;">認輔教師</span></div> </td> <td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 103.5pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="138"><div style="line-height: 20pt;"> </div> </td> <td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 85.95pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="115"><div style="line-height: 20pt;"><span style="font-size: 14pt;">晤談地點</span></div> </td> <td colspan="3" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 257.95pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="344"><div style="line-height: 20pt;"> </div> </td> </tr><tr><td colspan="6" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 539.4pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="719"><div style="line-height: 20pt;"><span style="font-size: 14pt;"> **(**</span>**<span style="font-size: 14pt;">一)</span>****<span style="font-size: 14pt;">個案起源 </span>**</div> </td> </tr><tr><td colspan="6" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 539.4pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="719"><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div> </td> </tr><tr><td colspan="6" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 539.4pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="719"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;"> **(**</span>**<span style="font-size: 14pt;">二)</span>****<span style="font-size: 14pt;">問題行為概述</span>**</div> </td> </tr><tr><td colspan="6" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 539.4pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="719"><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div> </td> </tr><tr><td colspan="6" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 539.4pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="719"><div align="center" style="line-height: 20pt;">**<span style="font-size: 14pt;">(</span>****<span style="font-size: 14pt;">三)個案背景</span>**</div> </td> </tr><tr><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 92pt; border-bottom-style: solid; background-color: transparent;" width="123"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">(1)</span><span style="font-size: 14pt;">家庭背景</span></div> </td> <td colspan="5" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 447.4pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="597"><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div> </td> </tr><tr><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 92pt; border-bottom-style: solid; background-color: transparent;" width="123"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">(2)</span><span style="font-size: 14pt;">學校生活</span></div> </td> <td colspan="5" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 447.4pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="597"><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div> </td> </tr><tr><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 92pt; border-bottom-style: solid; background-color: transparent;" width="123"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">(3)</span><span style="font-size: 14pt;">身心特質</span></div> </td> <td colspan="5" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 447.4pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="597"><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div> </td> </tr><tr><td colspan="6" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 539.4pt; border-bottom-style: solid; background-color: transparent;" width="719"><div align="center" style="line-height: 20pt;">**<span style="font-size: 14pt;">(</span>****<span style="font-size: 14pt;">四)備註</span>**</div> </td> </tr><tr><td colspan="6" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 539.4pt; border-bottom-style: solid; background-color: transparent;" width="719"><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div> </td></tr></tbody></table>

<div align="center" style="color: rgb(0, 0, 0); font-family: 'Trebuchet MS'; line-height: 20pt;"><span style="font-size: 18pt;">澎湖縣馬公國中 學年度認輔教師輔導個案諮商晤談記錄表</span></div><div style="color: rgb(0, 0, 0); font-family: 'Trebuchet MS'; line-height: 20pt;"> </div> <table border="1" cellpadding="0" cellspacing="0" style="width: 527.6pt; border-collapse: collapse; border-spacing: 0px; color: rgb(0, 0, 0); font-family: 'Trebuchet MS'; line-height: 26.6666641235352px; border: medium none;" width="703"><tbody><tr><td colspan="4" style="padding: 0cm 5.4pt; border: 1pt solid windowtext; vertical-align: top; width: 527.6pt; background-color: transparent;" valign="top" width="703"><div style="line-height: 20pt;"><span style="font-size: 14pt;">晤談時間： 年 月 日 時 分至 時 分</span></div> </td> </tr><tr><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 41.4pt; border-bottom-style: solid; background-color: transparent;" width="55"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">(</span><span style="font-size: 14pt;">一)輔導方式</span></div> </td> <td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 117pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="156"><div style="line-height: 20pt;"><span style="font-size: 14pt;">□當場發現</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□教師約談</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□學生來談</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□家長來談</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□家庭訪問</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□電話訪談</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□其他\_\_\_\_\_\_\_\_\_</span></div> </td> <td rowspan="3" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 36pt; border-bottom-style: solid; background-color: transparent;" width="48"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">談話主題</span></div> </td> <td rowspan="3" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 333.2pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="444"><div style="line-height: 20pt;"> </div> </td> </tr><tr><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 41.4pt; border-bottom-style: solid; background-color: transparent;" width="55"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">(</span><span style="font-size: 14pt;">二)行為類型</span></div> </td> <td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 117pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="156"><div style="line-height: 20pt;"><span style="font-size: 14pt;">□教室秩序</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□學習情緒</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□同儕相處</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□校內行為</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□師生互動</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□學業適應不良</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□家庭問題</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□其他\_\_\_\_\_\_\_\_</span></div> </td> </tr><tr><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 41.4pt; border-bottom-style: solid; background-color: transparent;" width="55"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">(</span><span style="font-size: 14pt;">三)情緒反應</span></div> </td> <td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 117pt; border-bottom-style: solid; background-color: transparent;" valign="top" width="156"><div style="line-height: 20pt;"><span style="font-size: 14pt;">□健談</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□溫和</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□沉默</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□坦白</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□悲傷</span></div><div style="line-height: 20pt;"><a name="OLE_LINK2" style="color: rgb(102, 102, 102); font-weight: bold;"><span style="font-size: 14pt;">□</span></a><span style="font-size: 14pt;">悔過</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□冷淡</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□自我防衛</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□生氣</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□憂鬱</span></div><div style="line-height: 20pt;"><span style="font-size: 14pt;">□其他\_\_\_\_\_\_\_</span></div> </td> </tr><tr style="height: 126.9pt;"><td style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext; border-right-style: solid; border-left-style: solid; width: 41.4pt; border-bottom-style: solid; height: 126.9pt; background-color: transparent;" width="55"><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">(</span><span style="font-size: 14pt;">四)</span></div><div align="center" style="line-height: 20pt;"><span style="font-size: 14pt;">處置要點</span></div> </td> <td colspan="3" style="padding: 0cm 5.4pt; border-right-width: 1pt; border-bottom-width: 1pt; vertical-align: top; border-color: rgb(236, 233, 216) windowtext windowtext rgb(236, 233, 216); border-right-style: solid; width: 486.2pt; border-bottom-style: solid; height: 126.9pt; background-color: transparent;" valign="top" width="648"><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div style="line-height: 20pt;"> </div><div> </div> </td></tr></tbody></table>

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