ENTREVISTA COM PAIS OU CUIDADORES /ANAMNESE

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ESCOLA:______________________________________________________________________

SÉRIE:_________________________________
RESPONSÁVEL:___________________________________________________________________________________
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QUEIXA:_________________________________________________________________________________________
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ENCAMINHAMENTO:
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TRIAGEM

GESTAÇÃO:

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PARTO:

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MARCADORES:

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ALIMENTAÇÃO:

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SONO:

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INDEPENDÊNCIA DA CRIANÇA:

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RELATO A CERCA DO COGNITIVO ( indicam a habilidade de adquirir conhecimentos e desenvolver emoções,)

COMPORTAMENTAL E SOCIAL
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HISTÓRIA DE SAÚDE:

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MEDICAÇÃO:

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HISTÓRIA DA FAMÍLIA:

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ESCOLA:
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LAZER E HABILIDADES SOCIAIS :

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QUAIS MOMENTOS EM QUE PERCEBE PERDA DE INTERESSE, DISTRAÇÃO FALTA DE FOCO ?

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EXISTE MOMENTOS ESPECIFICOS PARA QUE APARECAM OS COMPORTAMENTOS INDESEJADOS , TAIS
COMO AGITAÇÃO , IMPULSIVIDADE E AGRESSIVIDADE ?

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EXISTE MOMENTOS QUE REALIZA ATIVIDADE DIRIGIDA E CONCLUI ? QUAL

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COMO VC PERCEBE QUE O PACIENTE TEM ABSORVIDOS OS CONTEUDOS DE SALA DE AULA OU DO

TRABALHO? QUAL O ENGAJAMENTO DA FAMILIA EM RELAÇAO A ESCOLA OU TRABALHO?
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COMO SE CONCEBE A RELAÇÃO DO PACIENTE COM SEUS PARES ?

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PACIENTE SOLICITA AJUDA SEMPRE QUE NECESSITA
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OUTRAS OBSERVAÇÕES
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