Beruflich Dokumente
Kultur Dokumente
ASPECTOS GENERALES:
CIUDAD: ________________________________-
“En mi clase aprenderás a pensar
Nombre: _________________________________- por
Fecha de Nacimiento:_______________________________-
ti mismo nuevamente. Aprenderás a
Edad: __________________________ ________
saborear la palabra lenguaje. No
Estado civil: ______________________________________
importa lo que digan los demás, las
Dirección : __________________________________-
palabras y las ideas pueden cambiar
Teléfono:_______________________________ __________
él
Barrio:__________________________________________
mundo”
Estrato: ____________________________________
(Sociedad de los Poetas
Muertos)
ASPECTOS FAMILIARES:
Ocupación:
Edad:
Estudios:
Dirección:
Teléfono:
Nombre de la madre:
Ocupación:
Edad:
Estudios:
Dirección:
Teléfono:
Otros________
Otros________
ASPECTOS CLINICOS:
El parto fue:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________
Complicaciones en el parto:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________
Cuantos: _______
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
Enfermedad asociada
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________
Observaciones:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
MOTORA FINA
Observaciones:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
LENGUAJE
Observaciones:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
COGNITIVO
Observaciones:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
AFECTIVO SOCIAL
Observaciones:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
HABITOS DE AUTOMOMIA PERSONAL
¿ Cual?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Observaciones:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Observaciones:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
ASPECTOS DE ESCOLARIDAD
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
__________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________
Observaciones escolares
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________