Anamnese

Nome: ___________________________________________________________
Data: ____/____/____
Idade: ______

Problema atual
Queixa principal:____________________________________________________
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Antecedentes: _____________________________________________________
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Consequentes: ____________________________________________________
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História familiar
Elemento Idade Habilitações Profissão Reside Observações
com
aluno
História pessoal
Lugar de nascimento__________________________________________
Lugares onde morou:________________________________________________
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Percurso casa/ escola

Distância:____________________________________________________
Transporte: __________________________________________________
Alojado: _____________________________________________________

Projetos do aluno:__________________________________________________
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Percurso escolar:
Ano de Apoio Ensino Apoio
escolaridade Ano letivo Escola especial psicológico

Retenções: ________________________________________________________
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Atividades
extracurriculares:___________________________________________________
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Dados relevantes da história de vida:___________________________________
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Hábitos sociais: ____________________________________________________
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Prática sexual: _____________________________________________________
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Relacionamento
familiar:___________________________________________________________
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Relacionamento
interpessoal:_______________________________________________________
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História médica (médico família; doenças; operações; acidentes; tratamentos):

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História nutricional (dieta habitual/prescrita; nº de refeições diárias, capacidade
preparar alimentos): ________________________________________________
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História de sono (quantidade/qualidade): ______________________________

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Personalidade prévia (actividades preferidas/interesses; atitude perante si
mesmo): __________________________________________________________
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Conduta (aparência, actividade diária e sentimento de vinculação):

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Resultado Avaliação Psicológica:

 Avaliação cognitiva (atenção, percepção, memória, raciocínio, capacidade
de abstracção, juízo crítico, pensamento, linguagem)
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 Avaliação do funcionamento afectivo
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 Recursos sociais (suporte familiar percebido e recebido, participação vida
familiar/comunitária)
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 Observação comportamental (aspecto, atitude, discurso)

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