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ANAMNESE - ADULTO

IDENTIFICAÇÃO

Nome do Paciente ____________________________________________________________

Sexo ____________________Idade _____________ Data de nascimento__________________

Estado Civil ___________________________________ Escolaridade ______________________

Profissão _____________________________________________________________________

Já fez acompanhamento psicológico?: ______________________________________________

Encaminhado por: ______________________________________________________________

Telefone para contato:___________________________________________________________

Telefone para emergencia: _______________________________________________________

QUEIXA PRINCIPAL E EVOLUÇÃO DA QUEIXA

(Quando iniciou, se teve agravamento, se toma medicamento, como esta se sentido no momento…)

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OBJETIVOS COM A TERAPIA:


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HISTÓRICO DE VIDA

-INFÂNCIA
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- ADOLESCÊNCIA
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-VIDA ADULTA
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RELACIONAMENTOS E DINÂMICA

-FAMILIAR

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- AMIZADES
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-AFETIVOS
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-PROFISSIONAIS
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OBS:

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