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ESCUELA DE PSICOLOGÍA.
SECCIÓN: 02
CICLO 02-2017
INSTRUCCIONES:
1. EDAD:
2 SEXO: F M
NO
NO
9. Cobertura de Salud.
Médico de Cabecera
NO SI
EVENTOS PRECIPITANTES:
1.
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3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
ENTREVISTA.
1) Aspecto físico:
2) Aspectos psicológicos:
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b) Historia afectiva vincular:
c) Duelos:
b) Actividades laborales:
c) Estado económico:
d) Desarrollo social:
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DIAGNOSTICO MULTIAXIAL:
EJE I: __________________________________
EJE III:
EJE V: _________________________________
CONCLUSIÓN:
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