Formato de Anamnesis

Empresa Social del Estado
HOSPITAL SAN FRANCISCO DE ASS ANZ

NIT: 890.397.282-3
Direccin: Cra 8 No. 7-29
Telfonos 8 52 20 29 - 8 52 20 79 - 8 52 20 80
Correo Electrnico: hospitalanza@hospitalanza.gov.co
ANAMNESIS
1. Identificacin
Fecha: ____________________________________________________________________________
Nombre:___________________________________________________________________________
Fecha de Nacimiento: ___________________________________edad:_________________________
Grado de Escolaridad: _______________ Institucin:________________________________________
Nombre de la educadora: ______________________________________________________________
Expectativas: _______________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Remitido por ________________________________________________________________________
Nombre de la madre__________________________________________________ Edad ___________
Escolaridad_______________ Ocupacin _______________________ Cdula ___________________
Nombre del padre ________________________________________________ Edad _____________
Escolaridad_______________ Ocupacin _______________________ Cdula ___________________
Se encuentra afiliado a alguna E.P.S: S ___ No___ Cul ____________________________________
Caja de Compensacin Familiar: S ___ No___ Cul ________________________________________
Direccin: ___________________________ Barrio_____________Telfono: ________________
COMPOSICION FAMILIAR
Nombre
Sexo
Edad
Parentesco
Grado de
escolaridad
Ocupacin
Observaciones
ANTECEDENTES
Incluyente y Comprometida con la Atencin Integral

NIT: 890.397.282-3
Telfonos 8 52 20 29 - 8 52 20 79 - 8 52 20 80
Familiares:__________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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Personales:
Prenatales:__________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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Perinatales:_________________________________________________________________________
___________________________________________________________________________________
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Postnatales:_________________________________________________________________________
___________________________________________________________________________________
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Desarrollo Motor:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Desarrollo del lenguaje:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Desarrollo Psico-social:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

NIT: 890.397.282-3
Telfonos 8 52 20 29 - 8 52 20 79 - 8 52 20 80
___________________________________________________________________________________
___________________________________________________________________________________
CONSIDERACIONES ETIOLGICAS
___________________________________________________________________________________
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HISTORIA EDUCATIVA Y TERAPUTICA
___________________________________________________________________________________
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SITUACIN ACTUAL
DIMENSIONES DEL DESARROLLO HUMANO Y COMPETENCIA CURRICULAR
Dimensin comunicativa:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
________

NIT: 890.397.282-3
Telfonos 8 52 20 29 - 8 52 20 79 - 8 52 20 80
Dimensin socio-afectiva:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
_______
Dimensin cognitiva:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
________
Dimensin corporal:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
________
Dimensin tica:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

NIT: 890.397.282-3
Telfonos 8 52 20 29 - 8 52 20 79 - 8 52 20 80
___________________________________________________________________________________
___________________________________________________________________________________
________
Dimensin esttica:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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___________________________________________________________________________________
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Dimensin Espiritual:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
______
Competencia Curricular:
Castellana, matemtica, ciencias sociales, ciencias naturales, educacin fsica, esttica, religin, lengua
extranjera, tecnologa:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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_________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

NIT: 890.397.282-3
Telfonos 8 52 20 29 - 8 52 20 79 - 8 52 20 80
___________________________________________________________________________________
___
ESTILO DE APRENDIZAJE:
___________________________________________________________________________________
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___________________________________________________________________________________
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INTELIGENCIAS MLTIPLES:
___________________________________________________________________________________
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CONSIDERACIONES AMBIENTALES:
Entorno familiar:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

NIT: 890.397.282-3
Telfonos 8 52 20 29 - 8 52 20 79 - 8 52 20 80
___________________________________________________________________________________
________
___________________________________________________________________________________
___________________________________________________________________________________
__
Entorno Escolar:
___________________________________________________________________________________
___________________________________________________________________________________
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Observaciones Generales:
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___________________________________________________________________________________
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___________________________________________________________________________________
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Elaborado por:
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

NIT: 890.397.282-3
Telfonos 8 52 20 29 - 8 52 20 79 - 8 52 20 80
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Formato de Anamnesis

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