Admisso__________________

Admisso__________________
Sada_____________________
Sada_____________________
Dados recolhidos por ________
Dados recolhidos por ________

Ficha
Fichade
deAnamnese
Anamnese
Instituio:
Jardim-de-infncia

Escola

Educadora

Professor

I - Identificao da Criana
Nome:____________________________________________________
Data Nascimento: __/__/___ Idade: ___ A ___ M
Naturalidade ___________ Instituio de Nascimento ______________
Morada:____________________________________________________
Contacto Urgente____________________________________________
II Agregado Familiar
Me:
Nome________________________________________
D. N. ___/ ___/ ___ Profisso __________ Habilitaes ________
Pai:
Nome ________________________________________
D. N. ___/ ___/ ___ Profisso __________Habilitaes _________
Outros elementos do agregado familiar
Nome

Idade

Parentesco

Profisso

III Etapas do Desenvolvimento

Como decorreu a gravidez:
(Gravidez desejada/ no desejada; vigilncia; sade da me, consumos nocivos)

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Perodo Peri-Natal

Parto
-

Quantas semanas: ____

Foi parto normal?

-

Sim

No

Cesariana Frceps Manobras de reanimao

Outro Qual? ________________________

- ndice de APGAR _______

Esteve na incubadora?
-

Sim

No

Durante quanto tempo? ___________________

Perodo Neo-Natal
- Informao Clnica: (Mdico assistente, Instituio, Diagnstico, Teraputica,
Internamentos, Acompanhamento e Terapias, outros
problemas)

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Antecedentes Familiares (Doenas Familiares e Hereditrias)

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- Sade
Varicela

Papeira

Sarampo

Tosse convulsa

Meningite Eczemas

Otites Infeces graves Alergias......................................

Febres altas e prolongadas Traumatismos.........................................
Acidentes...................................................................................................................
Intervenes cirrgicas........................................................................................
Hospitalizaes.........................................................................................................
Outros:............................................................................................................................

Apetite: Sim No
Dorme bem? Sim No Hora de despertar............
Hora de adormecer...........

Desenvolvimento Global

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Dia a dia da criana

(rotinas, brincadeiras, alimentao, sono)

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IV Situao Escolar

Frequenta:
Ama
Creche Qual? __________
Jardim-de-infncia Qual? ______
Educadora: _____________________

Observaes (Percurso Escolar e dificuldades apresentadas):

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Data
Data de
de recolha
recolha de
de dados:
dados: ____/____/____
____/____/____
Efectuada
Efectuada por:
por: ____________________________
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