Beruflich Dokumente
Kultur Dokumente
ANAMNESE
1.IDENTIFICAÇÃO
Nome____________________________________________________________
Sexo________________________________
Escolaridade______________________________________________________
Estado Civil_______________________________________________________
2. HISTÓRIA FAMILIAR
PAI MÃE
Idade
Habilitações Literárias
Profissão: Profissão:
Doenças Psíquicas
Doenças Fisicas
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Situação Conjugal dos Pais
Fratria
Idade
Sexo
Habilitações Literárias
Profissão
Saúde
Alcoolismo
Heroína/ Cocaína
Outros tóxicos
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3. COABITAÇÃO
Qual:
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Ambiente Familiar (inter-relações familiares, acontecimentos em relação aos
antecedentes, religião)____________________________________________________
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4. HISTÓRIA PESSOAL
Desejada_____ _____
Assistida_____ _____
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Parto
Local____________________________________________________________
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Condições ao nascer (normal, icterícia, anóxia, reanimação, transfusão, incubadora,
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Peso_________Kgs
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Alimentação
Artificial_____
Dificuldades alimentares__________________________________________________
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Desenvolvimento Psicomotor
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Diurno____________________________ Nocturno_____________________________
Observações____________________________________________________________
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Relação mãe / criança durante o primeiro ano de vida (idade do sorriso, medo de
estranhos, idade do não, afecto dominante na criança: triste, alegre, afectuoso, colérico)
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Doenças infantis (psicossomática 1ª infância) __________________________________
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Acidentes _____________________________________________________________
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Internamentos __________________________________________________________
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Sintomas diversos:
Mentira ________
contrariado )
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Autonomia
Sim Não
Adulto: Quando?
Escolaridade
Outros: _________________________________________________
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Desenvolvimento sócio - sexual( com colegas, timidez, isolamento, agressividade,
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Dificuldades especiais:
Quais? ________________________________________________________________
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Repetência:
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Gostou da escola: Sim ____ Não ____
Adaptação _____________________________________________________________
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Historial (atitude para a escola, relação com os colegas, relação com os
especificas ) __________________________________________________
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Frequência:
9º Ano ____
Adaptação _____________________________________________________________
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Repetência: ____________________________________________________________
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Ensino Secundário:
Adaptação _____________________________________________________________
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Passatempos e actividades (casa, rua, leituras, musica, TV, desporto, tarefas
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Adolescência
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Alimentação e saúde _______________________________________________
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d) Vida Adulta
Sim Não
Qual? _________________________________________________________________
religiosas) ______________________________________________________________
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Adaptabilidade e formas de relação (tipo de relação com os amigos;
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História Toxicofilica
Consumo Regular
Substância Especifique Inicio Via E.V.Início
Inicio Fim
Tabaco
Álcool
Álc. (abuso)
Cannabis
Sedativos
Estimulantes
Alucinogéneos
Opiáceos
Cocaína
Ecstasy
Outros
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Tratamentos já efectuados e com que resultados __________________________
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Vida social
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e) Personalidade
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Exemplos: _______________________________________________________
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Afecto (tem liberdade para exprimir os seus afectos ou está inibido) __________
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Realidade (costuma acertar nas suas previsões) __________________________
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Sistema defensivo:
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Reprime-se? ______________________________________________________
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Culpabiliza-se? ____________________________________________________
Sentido moral:
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Acha que a sua moralidade estagnou a determinada altura ou que evoluiu como
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Em que grau é que precisa de estima e da aprovação dos outros? _____________
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hostilidade? ______________________________________________________
e limitações? _____________________________________________________
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Como se sente perante uma situação embaraçosa? ________________________
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Habitação
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História somática (acidentes, intervenções cirúrgicas, hospitalizações, doenças)
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Observações ______________________________________________________
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B- OBSERVAÇÂO
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