Anamnese Criança

DADOS DE IDENTIFICAÇÃO

Nome:______________________________________________________________

Data de Nascimento:___________________ Idade:_________

Escolaridade:_______________________________________________________

Contato:___________________________________________________________

Já fez acompanhamento psicológico? ___________________________________

Encaminhado por:___________________________________________________

DADOS DE IDENTIFICAÇÃO DOS PAIS

Nome Pai:___________________________________________________________

Profissão:___________________________________________________________

Estado civil:__________________________________________________________

Nome Mãe:__________________________________________________________

Profissão:___________________________________________________________

Estado civil:_________________________________________________________

QUEIXA PRINCIPAL

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Início da queixa:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Quais as mudanças que ocorreram/ o que afetou:

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

QUEIXAS SECUNDÁRIAS:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

GESTAÇÃO E PARTO

Planejada( ) Desejada ( ) Pré-natal ( ) Abortos antecedentes ( )

Normal ou Cesária:___________________________________________________
Como foi o parto, teve dificuldades:_______________________________________
___________________________________________________________________
Estado emocional durante a gravidez e após o parto:________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Quem cuidou do bebe ao nascer:________________________________________
OBS:_______________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
HISTÓRIA FAMILIAR

Quem mora na casa? _________________________________________________

___________________________________________________________________

Como são os relacionamentos em casa?__________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Eventos Significativos e observações:

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

HISTÓRIA SOCIAL E PESSOAL

Quais são as qualidades e os pontos fracos?_______________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Relações com o proprio corpo e autoestima:________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Possui alguma questão psicológica/psiquiátrica? Usa medicamento? ____________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Como é a rotina (antes e depois da pandemia e quais as principais mudanças)

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

O que você e seus amigos fazem para se divertir?___________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Você pratica esportes ou outras atividades?________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Questões com a sexualidade?___________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Questões relevantes:

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
DADOS ESCOLARES

Qual a relação com a escola? ___________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Já teve problemas na escola?___________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Como estão as suas notas? Alguma mudança recente? ______________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
__________________________________________________________________

Como é a relação com os amigos da escola ________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Você já teve que repetir alguma matéria ou ano? (Por quê?) __________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

CONSIDERAÇÕES FINAIS E APONTAMENTOS IMPORTANTES

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________