Servio de Aconselhamento e Acompanhamento

FICHA INDIVIDUAL
Proc.
N:___________
Motivo do
pedido:______________________________________________________________
Pedido feito
por:_______________________________________________________________

IDENTIFICAO
Nome do aluno:
________________________________________________________________
Morada:
______________________________________________________________________
Telefone: _______________________
e-mail:
_______________________________________
Data de nascimento:____________________________________
Idade:______________
Naturalidade:_______________________________________________________________
___
Escola que frequenta: _______________________________________
________

Pgina 1 de 8

Ano:

Local de
trabalho:_______________________________________________________________

AGREGADO FAMILIAR
Quantos so?___________
Nome/Grau de
parentesco

Escolaridade

Profisso/Ocupao

Idade

HISTRIA FAMILIAR
Me:________________________________________________________________________
_
Idade: _____ Hab. Literrias: ____________________ Profisso:
_________________
Naturalidade:_________________________________________
Estado
Civil:_________
Morada:_____________________________________________________________________
_
Cont. Telef:_________________________ email:_________________________________
Pai:
__________________________________________________________________________
Idade: _____ Hab. Literrias: ___________________
_
Profisso:
_________________
Naturalidade:_________________________________________
Estado
Civil:_________
Morada:_____________________________________________________________________
_
Cont. Telef:_________________________ email:_________________________________
N. de Irmos:__________
Nome
Escolaridade

Ocupao

Idade

Observaes e aspectos a salientar como alteraes na constituio ou no

agregado familiar (separaes, mudanas, )
_____________________________________________________________________________
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Problemas psicolgicos especficos em familiares:
_____________________________________________________________________________
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_____________________________________________________________________________
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SITUAO ESCOLAR/PROFISSIONAL
Histria pr-escolar e escolar (contextos frequentados, como creche, jardim
de infncia, av, amas, n de repetncias, adaptaes e primeiras reaces,
):
_____________________________________________________________________________
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_____________________________________________________________________________
_____________________________________________________________________________
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Escola/Instituio que
frequenta:__________________________________________________
Curso:_____________________________________________________________
Ano:_______
Horrio:_____________________________________________________________________
_
Situao
profissional:___________________________________________________________
Quantos empregos teve?______________ Porque saiu?
_______________________________
Funes
desempenhadas:________________________________________________________
Contextos de socializao e actividades frequentados (cinema, dana,
escuteiros, ginsio, ):
_____________________________________________________________________________
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HISTRIA PESSOAL
Gravidez: Planeada?_____ Acidental?______Desejada?______ Ass. Mdica?
_______________
(pr-natal)
Problemas/doenas no decorrer da gravidez; se teve acompanhamento por
parte do pai da criana; testes realizados; medicao; consumo de lcool,
tabaco, cafena, outras drogas, ;
_____________________________________________________________________________
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Problemas/doenas maternos ou paternos:
_____________________________________________________________________________
_____________________________________________________________________________
Descrever o estado psico-emocional ao longo da gravidez:
_____________________________________________________________________________
_____________________________________________________________________________
(pri-natal)
Parto:
____________________________________________Complicaes:________________
Ouviu de imediato o choro do beb?__________ Dias de
hospitalizaes:__________________
(ps-natal)
Amamentao? _______________At que idade? __________ 1s passos (idade):
__________

HISTRIA DESENVOLVIMENTAL
Linguagem (idade das 1s palavras e outras caract); controle esfincteriano;
rotina e hbitos do sono e do adormecer; problemas alimentares:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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Problemas de sade:
Convulses

Quedas

Insolao

Meningite

Sarampo

Papeira

Varicela

Rubola

Hepatite

Otites

Pediatra/mdico
assistente:______________________________________________________

Pgina 4 de 8

Infece
s
?

Problemas do comportamento considerados relevantes:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Habitao (descrio)
Divises:____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
__
Actualmente (sade, autonomia, relaes, ):
Dormir/Sono
Rotina para adormecer: ________________________________________ Horas de
sono:_____
Dificuldades:
__________________________________________________________________
Alimentao
Refeies dirias:________ Dificuldades/alergias/alimentao
regrada:___________________
_____________________________________________________________________________
_____________________________________________________________________________
Higiene e cuidados pessoais (higiene dentria, banho, vesturio):
_____________________________________________________________________________
_____________________________________________________________________________
Problemas de sade/operaes/internamentos/medicao especfica:
_____________________________________________________________________________
_____________________________________________________________________________
Existncia de medos/fobias:
_____________________________________________________________________________
_____________________________________________________________________________
O que faz para se ocupar em casa (leitura, bordar, costurar, jogos, ):
_____________________________________________________________________________
_____________________________________________________________________________
Comunicao e relaes interpessoais (com quem e com que frequncia):
_____________________________________________________________________________
_____________________________________________________________________________
Tem dificuldades ao nvel da comunicao, compreenso e expresso:
_____________________________________________________________________________
_____________________________________________________________________________
Descrever como faz para comunicar:
_____________________________________________________________________________
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Relao com os educadores/professores/colegas de trabalho/superiores:

Pgina 5 de 8

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Relao com os vrios familiares (irmos, tios, avs, ):
_____________________________________________________________________________
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Relao com outros adultos:
_____________________________________________________________________________
_____________________________________________________________________________
Descrever o relacionamento mais significativo:
_____________________________________________________________________________
_____________________________________________________________________________
H dificuldades de relacionamento? Quais?
_____________________________________________________________________________
_____________________________________________________________________________
Descrio de um dia (com quem se cruza, como se sente, ):
_____________________________________________________________________________
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Drogas (cafena, lcool, lsd, ervas, cogumelos mgicos,)
Experincia com drogas?_____________ Quais?
______________________________________
Freq.:____________________________ Sente-se viciada/o?
____________________________

Pgina 6 de 8

CARACTERIZAO DO PEDIDO
Aspectos preocupantes para os pais (inicio); comportamentos
problemticos:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Histria do problema actual:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
O que j foi feito para tentar resolver:
Recurso a outros servios (locais, datas de exames mdicos ou psicolgicos
efectuados, )
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Opinio dos outros acerca desses problemas (educadora, professora,
colegas, famlia, )
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Observaes:
_____________________________________________________________________________
_____________________________________________________________________________
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