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CONTENTS ORIGINAL ASSESSMENT SHEET WHEN IS THE ORIGINAL ASSESSMENT SHEET DONE WHO DOES THE ORIGINAL ASSESSMENT SHEET PURPOSE OF ORIGINAL ASSESSMENT SHEET HOW IS THE ORIGINAL ASSESSMENT SHEET DONE NEATNESS OF ORIGINAL ASSESSMENT SHEET WHERE DOES THE ORIGINAL ASSESSMENT SHEET GO WHEN COMPLETED ORIGINAL ASSESSMENT SHEET A. FAMILY: B. MARITAL STATUS: C. EDUCATION LEVEL: D. PROFESSIONAL LIFE: E. DRUGS: F. LOSSES: G. DEATHS: H. UPSETS: I. DANGERS: J. ACCIDENTS: K. ILLNESSES: L. OPERATIONS: M. PRESENT PHYSICAL CONDITION: N. PT ILLNESSES: O. DISABILITY PAYMENT OR PENSION: P. ANY FAMILY HISTORY OF INSANITY: Q. EYES: E-Meter Reaction R. BODY WEIGHT: S. ANY PERCEPTION DIFFICULTIES: T. ANY PERCEPTION TROUBLE IN FAMILY: U. SICK OR DISABLED FAMILY: V. EARLIER ALLIES OR CLOSE FRIENDS: W. HUSBAND OR WIFE PHYSICAL TROUBLES: X. ATTITUDE TOWARDS ILLNESS: Y. ATTITUDE TOWARDS TREATMENT: Z. ANY CURRENT TREATMENT IN PROGRESS: AA. COMPULSIONS, REPRESSIONS AND FEARS: BB. CRIMINAL RECORD: CC. INTERESTS AND HOBBIES: DD. ARE YOU HERE ON YOUR OWN SELF-DETERMINISM? EE. PREVIOUS DIANETIC OR SCIENTOLOGY PROCESSING: FF. GG. FORMER PRACTICES: HH. What problems are you trying to solve by processing? II. Have you ever done anything harmful to Dianetics, Dianeticists, Scientology, Scientologists or organizations? JJ. REALITY FACTOR: Cохранить документ себе Скачать
HUBBARD COMMUNICATIONS OFFICE
Saint Hill Manor, East Grinstead, Sussex
HCO BULLETIN OF 24 JUNE 1978R
REVISED 22 SEPTEMBER 1978
(Cancels BTB 24 Apr 69RA,
Preclear Assessment Sheet)
Remimeo BPI HGC All Auditors (Revisions in this type style) New Era Dianetics Series 5R

ORIGINAL ASSESSMENT SHEET

WHEN IS THE ORIGINAL ASSESSMENT SHEET DONE

This Original Assessment Sheet is done as the beginning action of Dianetics. It is done in a formal Dianetic auditing session in an auditing room with the pc duly signed up, and in session.

WHO DOES THE ORIGINAL ASSESSMENT SHEET

The auditor assigned to audit the preclear does the assessment. It is included as part of the preclear’s auditing time as it is valuable data collection on the preclear’s case, done with the preclear on the meter.

PURPOSE OF ORIGINAL ASSESSMENT SHEET

The purpose of this form is to provide essential data regarding the preclear to the C/S, the D of P and the auditor, and to better acquaint the auditor with the preclear at the onset of auditing.

HOW IS THE ORIGINAL ASSESSMENT SHEET DONE

The assessment is done with the preclear on the meter.

The preclear is given the R-Factor that you will simply be asking him for essential data about himself for the purpose given above.

The auditor notes down the data as the pc gives it. He does not take up the pc’s answers to the questions, except, when necessary, to make sure the question is answered and the auditor has the facts straight. TA at start and end of the assessment is noted, along with any TA action during the assessment. Needle reactions to the questions are noted when the question is given plus any needle reaction that occurs during the pc’s reply.

NEATNESS OF ORIGINAL ASSESSMENT SHEET

The data should be written plainly and neatly on the assessment sheet so that it is readable, as the information is wanted. Auditor does not delay or hold up the pc giving answers, however, while he completes admin.

WHERE DOES THE ORIGINAL ASSESSMENT SHEET GO WHEN COMPLETED

When completed, the Original Assessment Sheet is kept in the preclear’s folder. A note is made on the Summary Sheet of pc’s folder that the Original Assessment Sheet has been done.

ORIGINAL ASSESSMENT SHEET

Name of pc: ________Age of pc: ________
Auditor: ________Org: ________

TA Position at Start of Assessment: ________

A. FAMILY:

1. Is mother living? ________________ E-Meter Reaction ____________

2. Date of Death: ________________ E-Meter Reaction ____________

3. Pc’s statement of relationship with mother: _____________________________ E-Meter Reaction ____________

4. Is father living? ________________ E-Meter Reaction ____________

5. Date of Death: ________________ E-Meter Reaction ____________

6. Pc’s statement of relationship with father: _____________________________ E-Meter Reaction ____________

7. List brothers, sisters, and other relatives of the pc, date of death of any and E-Meter reaction:

RelationDate of DeathE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

8. Where and with whom do you live? _______________________ E-Meter Reaction _______________

9. Are you currently associated with anyone who is antagonistic to mental or spiritual treatment or Scientology?

(If yes, who?):E-Meter Reaction
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________

On questions 10 through 17 if the answer is “yes” find out who and E-Meter reaction.

10. Is anyone actively objecting to your getting treatment? _______________________

11. Has anyone insisted you get treatment? _______________________

12. Has anyone ever objected to your getting treatment? _______________________

13. Has anyone encouraged you to get treatment? _______________________

14. Has anyone ever objected to you getting better? _______________________

15. Has anyone ever assisted you in self-betterment? _______________________

16. Does anyone not like you the way you are? _______________________

17. Has anyone tried to make you change or be different? _______________________

B. MARITAL STATUS:

1. Married ______ Single ______ No. of times Divorced ________________ E-Meter Reaction __________

2. Pc’s statement of relationship with spouse: _______________________ E-Meter Reaction __________

3. List any marital difficulties pc presently has: _______________________ E-Meter Reaction __________

4. If divorced, list reasons for divorce and pc’s emotional feeling about divorce: _______________________ E-Meter Reaction __________

5. List children, date of death of any child and E-Meter reaction:

ChildrenDate of DeathE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
C. EDUCATION LEVEL:

State the level of schooling pc has had, university education, or professional training: _____________________ E-Meter Reaction ___________

D. PROFESSIONAL LIFE:

State main jobs pc has held:

JobE-Meter Reaction
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
E. DRUGS:

(NOTE: LIST DRUGS, MEDICINE OR ALCOHOL TAKEN THIS LIFETIME ONLY.)

1. Are you taking any drugs currently?

What DrugDate (How Long)E-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

Have you ever taken drugs?

What DrugDateE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

2. Are you taking any alcohol or alcoholic drink currently?

What Alcohol/Alcoholic DrinkDate (How Long)E-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

Have you ever taken alcohol or alcoholic drinks?

What Alcohol/Alcoholic DrinkDateE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

3. List any medicine currently or previously taken.

WhatWhen (How Long)E-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
F. LOSSES:

What severe losses have you had in life that influenced it?

LossDateDescriptionE-Meter Reaction
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
G. DEATHS:

What deaths have severely affected your life?

DeathDateDescriptionE-Meter Reaction
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
H. UPSETS:

Are you upset with or cross about anything or anyone at this particular time?

UpsetDateDescriptionE-Meter Reaction
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
I. DANGERS:

1. Are you in any particular danger at this time?

DescriptionE-Meter Reaction
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________

2. Are there engrams that match this in the past?

(Note meter read.) ____________________

J. ACCIDENTS:

List any serious accidents pc has had, the date of such, any permanent physical damage, and E-Meter reaction.

AccidentDatePhysical DamageE-Meter Reaction
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
K. ILLNESSES:

List any serious illness pc has had giving date of each, any permanent-physical damage, and E-Meter reaction.

IllnessDatePhysical DamageE-Meter Reaction
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
L. OPERATIONS:

List any operation, the date of each and E-Meter reaction.

OperationDateE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
M. PRESENT PHYSICAL CONDITION:

List any bad physical condition pc presently has and E-Meter reaction to such.

Physical ConditionE-Meter Reaction
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
N. PT ILLNESSES:

1. List any illnesses the pc currently has.

IllnessDateE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

2. Do you have any recurring physical ailment? _____________ E-Meter Reaction _________

O. DISABILITY PAYMENT OR PENSION:

List any disability payment or pension received by the pc, what it is for, how much and for how long it has been received.

What ForHow MuchDurationE-Meter Reaction
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
P. ANY FAMILY HISTORY OF INSANITY:
WhoWhatWhenE-Meter Reaction
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Q. EYES: E-Meter Reaction
Реакция Е-метра
Any tint in eye white___________________________________
Eye Color___________________________________
Color Blindness___________________________________
Glasses___________________________________
R. BODY WEIGHT:
Реакция Е-метра
Overweight?____________________________________
Underweight?____________________________________
S. ANY PERCEPTION DIFFICULTIES:
WhatE-Meter Reaction
________________________________________
________________________________________
________________________________________
T. ANY PERCEPTION TROUBLE IN FAMILY:
E-Meter Reaction
________________________________________
________________________________________
________________________________________
U. SICK OR DISABLED FAMILY:
E-Meter Reaction
________________________________________
________________________________________
________________________________________
V. EARLIER ALLIES OR CLOSE FRIENDS:
E-Meter Reaction
________________________________________
________________________________________
________________________________________
W. HUSBAND OR WIFE PHYSICAL TROUBLES:
WhatE-Meter Reaction
________________________________________
________________________________________
________________________________________
X. ATTITUDE TOWARDS ILLNESS:
E-Meter Reaction
________________________________________
________________________________________
________________________________________
Y. ATTITUDE TOWARDS TREATMENT:
E-Meter Reaction
________________________________________
________________________________________
________________________________________
Z. ANY CURRENT TREATMENT IN PROGRESS:
E-Meter Reaction
________________________________________
________________________________________
________________________________________
AA. COMPULSIONS, REPRESSIONS AND FEARS:

List any compulsions (things pc feels compelled to do), repressions (things pc must prevent himself from doing) and any fears of pc.

Compulsions:E-Meter Reaction
________________________________________
________________________________________
________________________________________
Repressions:E-Meter Reaction
________________________________________
________________________________________
________________________________________
Fears:E-Meter Reaction
________________________________________
________________________________________
________________________________________

Are you trying to change something someone else doesn’t like?

What and WhoE-Meter Reaction
________________________________________
________________________________________
BB. CRIMINAL RECORD:

List any crime committed by pc, prison sentence, if any.

CrimeSentenceE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
CC. INTERESTS AND HOBBIES:

List any interests and hobbies of pc.

Interests and HobbiesE-Meter Reaction
________________________________________
________________________________________
________________________________________
________________________________________
DD. ARE YOU HERE ON YOUR OWN SELF-DETERMINISM?
_________________________E-Meter Reaction _____________
EE. PREVIOUS DIANETIC OR SCIENTOLOGY PROCESSING:

1. List auditors, hours, and E-Meter reaction to any processing done.

AuditorHoursE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

2. List briefly processes run:

_________________________
_________________________
_________________________

3. List goals attained from such processing:

E-Meter Reaction
________________________________________
________________________________________
________________________________________

4. List goals not attained from such processing:

E-Meter Reaction
________________________________________
________________________________________
FF.

1. Do you look on yourself as somebody else?

E-Meter Reaction
________________________________________
________________________________________
________________________________________

2. When you see pictures of the past do you see yourself from a distance?

E-Meter Reaction
________________________________________
________________________________________
________________________________________
GG. FORMER PRACTICES:

1. What practices or treatments have you engaged upon in the past?

Practice or TherapyDateE-Meter Reaction
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

2. Are you continuing any of the above in the present?

_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
HH. What problems are you trying to solve by processing?
E-Meter Reaction
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
II. Have you ever done anything harmful to Dianetics, Dianeticists, Scientology, Scientologists or organizations?
_________________________
_________________________
_________________________
_________________________
_________________________
JJ. REALITY FACTOR:

You know of course that people sometimes get cross at the auditor or run away when they are withholding information from them and we don’t want you to do that.

Anything you tell me is confidential and is protected under ministerial confidence.

Is there anything we have missed or omitted while doing this assessment? (Carefully note any meter reads.)

Ask: “Is there anything you would care to tell me about this?”

_________________________
_________________________
_________________________
_________________________
_________________________

State of needle at the end of the above _________________

L. RON HUBBARD
Founder
LRH:ldv.dr