Accede a apuntes, guías, libros y más de tu carrera

historiaclnicapsicolgica-nios-phpapp01

4 pag.

Descargado por Vianey Martínez

(vianeylinda2009@hotmail.com)
Encuentra más documentos en www.udocz.com
 HISTORIA CLÍNICA PSICOLÓGICA
1. DATOS DE IDENTIFICACIÓN
Nombre:…………………………………………………………………………………………………………………………………………………
Lugar y fecha de nacimiento:………………………………………………………………………………………………………………….
Edad:………………………………………………………………………………………………………………………………………………………
Sexo:………………………………………………………………………………………………………………………………………………………
Raza:………………………………………………………………………………………………………………………………………………………
Nivel de escolaridad:………………………………………………………………………………………………………………………………
Religión:………………………………………………………………………………………………………………………………………………….
Nombre de la madre:……………………………………………………………………………………………………………………………..
o Residencia:…………………………………………………………………………………………………………………………………
o Procedencia:………………………………………………………………………………………………………………………………
Nombre del Padre:…………………………………………………………………………………………………………………………………
o Residencia:…………………………………………………………………………………………………………………………………
o Procedencia:………………………………………………………………………………………………………………………………
Lugar de residencia:……………………………………………………………………………………………………………………………….
Dirección domiciliaria:………………………………………………………………………………………………………………….………..
Numero de historia clínica:……………………………………………………………………………………………………………..…….
Fecha de ingreso:……………………………………………………………………………………………………………………………………
Teléfono:………………………………………………………………………………………………………………………………………………..
2. MOTIVO DE CONSULTA
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………..
3. HISTORIA DE LA ENFERMEDAD
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………....

Descargado por Vianey Martínez

(vianeylinda2009@hotmail.com)
Encuentra más documentos en www.udocz.com
 ...........................................................................................................................................................................
...........................................................................................................................................................................
...........................................................................................................................................................................
........................................................................................................................................................
4. ANAMNESIS PERSONAL NORMAL Y PATOLÓGICA
Prenatal:…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….…
……………………………………………………………………………………………………………………………………………………………….
Natal:…………………………………………………………………………………………………………………………………………………..…
…………………………………………………………………………………………………………………………………………………………….…
…………………………………………………………………………………………………………………………………………………………….…
Posnatal:……………………………………………………………………………………………………………………………………………..…
…………………………………………………………………………………………………………………………………………………………….…
……………………………………………………………………………………………………………………………………………………………….
Infancia:…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….…
……………………………………………………………………………………………………………………………………………………………….
5. ANAMNESIS FAMILIAR NORMAL Y PATOLÓGICA
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
6. HISTORIA SOCIAL
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
7. HISTORIA LABORAL
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………

Descargado por Vianey Martínez

(vianeylinda2009@hotmail.com)
Encuentra más documentos en www.udocz.com
 ……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
8. HISTORIA PSICOSEXUAL
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
9. EXAMEN DE FUNCIONES
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
10. ESTUDIO PSICOLÓGICO
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
11. DIAGNÓSTICO CLÍNICO Y CÓDIGO
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
12. EVOLUCIÓN Y TRATAMIENTO
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………

Descargado por Vianey Martínez

(vianeylinda2009@hotmail.com)
Encuentra más documentos en www.udocz.com
 ……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
13. PRONOSTICO
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
14. FUENTE DE INFORMACIÓN
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………

Firma

Descargado por Vianey Martínez

(vianeylinda2009@hotmail.com)
Encuentra más documentos en www.udocz.com