ROTEIRO DE ANAMNESE 2 - NEUROPSICOPEDAGOGIA - PSICOPEDAGOGIA - PEDAGOGIA 2014.8
Autor: Carlos E Wolf | Publicado: 2014-08-11T20:31:00-03:00



FALC
ROTEIRO DIAGNÓSTICO PSI CLI INSpsicopedagogiaANAMNESE.2 -
Polo Itaquera estrela Guia 2014.8&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;


Curso: PSICOPEDAGOGIA
CLÍNICA &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;

&nbsp;Disciplina:
ESTUDO
DE CASO EM PSICOPEDAGOGIA &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(ROTEIRO DE ANAMNESE 2) &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;Professor Autor: Carlos Eduardo Wolf &nbsp;

Comunique-se: ceywolf@yahoo.com.br &nbsp;&nbsp;&nbsp;(11)98684-4454 cel.&nbsp;&nbsp;&nbsp;&nbsp; (11)5588-4987 res.&nbsp;&nbsp;&nbsp;&nbsp; (11)2309-4454 office

Visite/Consulte: ceywolf.blogspot.com

NEUROPSICOPEDAGOGIA - PSICOPEDAGOGIA -
PEDAGOGIA

(ROTEIRO ANAMNÉSICO DE FINALIDADE CLÍNICA
E/OU INSTITUCIONAL)

Escólio
1:

O presente modelo de Roteiro
de Anamnese Psicopedagógica Clínica e/ou Institucional tem, por finalidade,
propiciar ao profissional Psicopedagogo, um ferramental que o auxilie em seu
trato investigativo as mais ideais condições possíveis de tabulação e
vinculação de dados e informações acerca do cognoscente atendido nos sets
clínico ou institucional, para que as hipóteses diagnósticas as quais construa
possam ser as mais detalhadas e claras possíveis, de profundo embasamento,
corroborado pela cientificação e certificação dos elementos próprios da
história do sujeito, permitindo que os futuros esquemas prognósticos elaborados
e, se necessário, somados aos de outros profissionais,que &nbsp;resultem em alta performance de sucesso,
baseado na fidelidade e veracidade das informações registradas e o cunho ético
do trabalho investigativo assumido pelos profissionais envolvidos. 

Escólio
2: 

Este Roteiro vem somar
esforços aos interessados em uma Anamnese cientificamente elaborada, na medida
em que a riqueza de dados amealhados sobre o paciente cognoscente, seu rol
familiar e escolar possam ser tabulados na construção diagnóstica aberta a mais
detalhamento que possa ser sugerido, possibilitando a concretude ajuntada a
partir de dados abstratos esparsos, na formação e elaboração do histórico de
vida do sujeito, sempre em conformidade ao cunho ético-científico atribuído à
linha de investigação sócio psicopedagógica que se faça necessária na busca de
resolução de problemas alinhados ao universo da aprendizagem e das possíveis comorbidades
acompanhantes. Fica, portanto, aberto, este modelo de Roteiro de Anamnese, a
toda e qualquer observação e questionamento adicional, com a finalidade de
enriquecimento, melhoria e adequação aos fins nele propostos.

Prof. carlos E.
Wolf.&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

ANAMNESE PSICOPEDAGÓGICA
CLÍNICA
e/ou INSTITUCIONAL

<!--[if !supportLists]-->1.&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]-->DADOS
PESSOAIS DO PACIENTE COGNOSCENTE &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;PRONTUÁRIO Nº_____________________ 

Em_____/______/
20________

Nome:
_____________________________________________________________________________________________Idade:_________
anos

Tem
apelido? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp; Qual? _________________________________________________________________
Ele (a) gosta? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N

Por
quê?______________________________________________________________________________________________________________

Origem
do apelido:__________________________________________________________________________
Tempo de apelido:_____________

Nascimento
_______/_______/_______&nbsp; Sexo (&nbsp;&nbsp;&nbsp; ) M&nbsp;
(&nbsp;&nbsp;&nbsp; ) F&nbsp;&nbsp; Naturalidade: ________________________________________________________

End.
_________________________________________________________________________________________________________________

Bairro:________________________________________
Cidade:_______________________________________ CEP ______________-_______

Fones
para contato:_____________________________________________________________________________________________________

E-mail:________________________________________________________________________________________________________________

Escola:__________________________________________________________Série
que cursa: _________ Cursou até:__________ Ano:_______

End.__________________________________________________________________________________________________________________

Fone:____________________________________________________________Contato:______________________________________________

Profª:________________________________
Coord. Resp.:____________________________ Horário:__________________________________

Pai:__________________________________________________________________________________________________
Idade:__________

Estudou
até________________________________________________________ Teve Dificuldade?
(&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Se formou? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Profissão
_____________________________________________________________________________________________________________

Está
empregado?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp; Obs.:_____________________________________________________________________________________

Mãe:_________________________________________________________________________________________________
Idade:__________

Estudou
até________________________________________________________ Teve Dificuldade?
(&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Se formou? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Profissão
_____________________________________________________________________________________________________________

Está
empregada?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp; Obs.:_____________________________________________________________________________________

Irmãos:
(nome e idade):

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Esquema
Familiar: (traços relacionais de algum destaque): ______________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________




<!--[if !supportLists]-->2.&nbsp;&nbsp;&nbsp;&nbsp; <!--[endif]-->DA QUEIXA

Na
escola?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Indicado
por?__________________________________________________________________________________________________________

Em
que acha que o profissional poderá ajudá-lo (a)?
___________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________




<!--[if !supportLists]-->3.&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]-->HISTÓRIA DE VIDA

<!--[if !supportLists]-->3.1.&nbsp; <!--[endif]-->CONCEPÇÃO

Filho
(a) planejado(a)&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;&nbsp;
(&nbsp;&nbsp;&nbsp; ) N;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; desejado (a)?&nbsp; (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Você queria
engravidar?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Foi
acidental (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N

Perturbou
a vida do casal ou de um dos pais?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp; Qual?______________&nbsp;&nbsp;&nbsp;&nbsp; Por quê?&nbsp;&nbsp;
____________________________________ _____________________________________________________________________________________________________________________
Como foi a gestação? (cuidados pré-natais, doenças, sintomas,
alimentação):_______________________________________________________

Como
foi o parto? (sofrimento fetal, má oxigenação, lesões): 

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

<!--[if !supportLists]-->3.2.&nbsp; <!--[endif]-->AMAMENTAÇÃO: (defasagens, acidentes de
percurso, assimilação/acomodação, carga afetiva)

Mamou
no peito? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N 

Como
foi a passagem do peito para a mamadeira? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

E
para a papinha? ______________________________________________________________________________________________________

Hoje
tem hora para comer? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N Come depressa?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N Mastiga bem? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N Comem juntos? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Come
vendo TV? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N

<!--[if !supportLists]-->3.3.&nbsp; <!--[endif]-->ELIMINAÇÃO

Com
que idade parou de usar fraldas? _____________________________________________________________________________________

Como
foi a passagem para o troninho (segurava? molhava a roupa? brincava e saia
correndo era repreendido? 

Chorava?)
____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Como
eram as fezes?&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (&nbsp;&nbsp; ) líquida&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;(&nbsp;&nbsp; ) pastosa&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (&nbsp;&nbsp;
) ressecada&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (&nbsp;&nbsp; ) normal



<!--[if !supportLists]-->4.&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]-->EVOLUÇÃO PSICOMOTORA

Ficou
no cercadinho? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Engatinhou? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Usou andador?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )
S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; N&nbsp;&nbsp; Por quanto tempo?______________

Com
que idade andou?_____________________________________________________ Caía
muito? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N

Quem
ensinou a andar? _________________________________________________________________________________________________

Como
aprendeu a andar? ________________________________________________________________________________________________

Mostrava-se
corajoso (a) ao subir uma escada? (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N

Era
corajoso ao explorar, engatinhando, um novo espaço? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Era
inseguro (a)? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;Demonstrava reações diante do perigo?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; N&nbsp;&nbsp; Exemplo:_________________________________

_____________________________________________________________________________________________________________________

Com
quem andava melhor? ______________________________________________________________________________________________

Como
evoluiu a coordenação dos movimentos finos? (segurar um brinquedo, uma colher,
rabiscos que fazia) _____________________________

_____________________________________________________________________________________________________________________

E dos
grandes músculos? (Chutar uma bola, correr) ___________________________________________________________________________

_____________________________________________________________________________________________________________________

<!--[if !supportLists]-->4.1.&nbsp; <!--[endif]-->HOJE

É
estabanado (a)? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Sabe nadar?&nbsp; (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; É
agitado(a)?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Anda
de patins?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Anda de bicicleta sem rodinha? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Anda
a cavalo?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Sobe em árvores? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Demonstra
reações diante do perigo?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;
S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;
N&nbsp;&nbsp;
Exemplo:_______________________________________________________________

_____________________________________________________________________________________________________________________

<!--[if !supportLists]-->4.2.&nbsp; <!--[endif]-->FALA

Com
que idade começou a falar? _____________________________ Com quem falava
mais?_________________________________________

Falava(m)
para ele (a) repetir? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N

Quais
foram às primeiras palavras? ________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Trocava
letras? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp; Quais? _____________________________________________________________________________________

Falava
muito errado? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp; Era repreendido(a) para falar
corretamente?&nbsp; (&nbsp; &nbsp;&nbsp;&nbsp;)&nbsp;
S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;
N&nbsp;&nbsp;&nbsp; Como?_____________________________

_______________________________________________&nbsp;&nbsp; Por quem?____________________________________________________________

<!--[if !supportLists]-->4.3.&nbsp; <!--[endif]-->HOJE

Troca
letras? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Fala
muito / pouco (ansioso)? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Volume
da fala:&nbsp;&nbsp; &nbsp;Baixo (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;Normal&nbsp;
(&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;Alto&nbsp;
(&nbsp;&nbsp;&nbsp;&nbsp; )

Fala
de uma forma que todos entendem? (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Gagueja?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Em quais
situações?____________________________

_____________________________________________________________________________________________________________________

Dê um
exemplo de como ele (a) fala: _______________________________________________________________________________________

Consegue
dar um recado? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N

Faz
uma compra sozinho (a)?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Conta
uma história / um caso / uma novela?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Dê um
exemplo:________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Você
entende o que ele (a) conta?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Tem começo, meio e fim?&nbsp; (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Há quebra no discurso?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; N

<!--[if !supportLists]-->4.4.&nbsp; <!--[endif]-->SONO

É
agitado? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;É
sonâmbulo?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;Tem pesadelos? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Sofre de Bruxismo&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; N

A
quanto tempo?__________________________________________________________________
Dorme com protetor dental?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;
S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp; N
Dorme só ou acompanhado?________________________________ Com quantas pessoas?
__________________________________________

Quando
acorda vai para a cama dos pais?&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp; É aceito(a) para lá ficar?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; N

Tem
medo de dormir sozinho?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Dorme no escuro?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Enurese noturna?&nbsp; (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N&nbsp; 

Com que
frequência?____________________________________________________________________________________________________

<!--[if !supportLists]-->5.&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]-->HISTÓRIA CLÍNICA:

Quais
doenças apresentou:

Bronquite?&nbsp; (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Alergia?&nbsp;
(&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Asma? (&nbsp;&nbsp;&nbsp;
) S&nbsp; (&nbsp;&nbsp;&nbsp; ) N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Viroses infantis?&nbsp; (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Internações?&nbsp;
(&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Cirurgias?&nbsp;
(&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

Outras
doenças: ________________________________________________________________________________________________________

Tratamentos
realizados (fonoaudiólogo, psicólogo, outros)&nbsp;&nbsp;&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;
) S&nbsp; (&nbsp;&nbsp;&nbsp; ) N

Qual?&nbsp; ________________________________________________________________________________________________________________

Há
alguma sequela?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;
S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;
N&nbsp;&nbsp;&nbsp;
Qual?________________________________________________________________________________

Problemas
de visão?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Audição?&nbsp;&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;
) S&nbsp; (&nbsp;&nbsp;&nbsp; ) N

Problemas
psicossomáticos (verificar os possíveis deslocamentos e a eventual relação com
a não aprendizagem):

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________


<!--[if !supportLists]-->6.&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]-->HISTÓRIA DA FAMÍLIA NUCLEAR

Fatos
marcantes dos pais e irmãos (antes, durante e depois da entrada do paciente
cognoscente na família):

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

<!--[if !supportLists]-->6.1.&nbsp; <!--[endif]-->ESTIMULAÇÃO:

A
criança tem acesso a:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 

Brinquedos
pedagógicos? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;Jogos? (&nbsp;&nbsp;&nbsp;
) S&nbsp; (&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Revistas? livros
? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Brinquedos eletrônicos? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Tem muitos brinquedos?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp;
)&nbsp; N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Enjoa rápido de alguma novidade?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp; S&nbsp;&nbsp;
(&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp; N

De
que atividades ele (a) participa:

Música?&nbsp; (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Dança ? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Esporte? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N Qual?_________________________________________________________________________________________________________________

<!--[if !supportLists]-->6.2.&nbsp; <!--[endif]-->SITUAÇÕES NEGATIVAS VIVENCIADAS PELA
CRIANÇA (através de alterações familiares)

Nascimento
de irmãos (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Mudanças (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Desempregos (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp; &nbsp;) N&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Separações (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Mortes
(&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp; De quem?&nbsp;
_________________________________________________________________________________________

&nbsp;Duração do
luto:__________________________&nbsp; Como
superou?________________________________________________________________

<!--[if !supportLists]-->7.&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]-->HISTÓRIA DA FAMILÍA AMPLIADA

Família:
(Passado, Presente, Interferências, Ligações, Quadros Patológicos)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Forma
de Disciplina:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Atitude
dos pais diante da falta de limite do filho (a): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Como
a criança reage?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Tem
alguém que a protege? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp; Quem? __________________________________________&nbsp; Como é a proteção?_______________

_____________________________________________________________________________________________________________________

É
muito censurada?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp; Motivo da censura:________________________________________________________________________

Relaciona-se
bem com:&nbsp; &nbsp;O pai? (&nbsp;&nbsp;&nbsp;
) S&nbsp; (&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;A mãe?
(&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Os
irmãos? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Parentes?&nbsp;
(&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp; S&nbsp;&nbsp;
(&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp; N 

Os
pais sabem ler e escrever?&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Quem
o auxilia na lição de casa?__________________________________________________________________________________________

Problema
que a família está passando no momento:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Como
é o ambiente de brincadeira no dia a dia? Quais brincadeiras?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Qual
prefere?__________________________________________________________________________________________________________

Como
se relaciona com os colegas? ________________________________________________________________________________________

É
líder?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;É ativo&nbsp;
(&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Passivo&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Chora nas brincadeiras?&nbsp; (&nbsp;&nbsp;&nbsp; )
S&nbsp; (&nbsp;&nbsp;&nbsp;
) N

Qual
o programa preferido na TV? __________________________________________________________________________________________

Qual
período mais assiste? _______________________________ Quantas horas/dia?_________________
Tem TV no seu quarto?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N

Assiste
TV durante as refeições?&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;
S&nbsp;&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; ) &nbsp;N

Assunto
ou lazer que interessa à criança: 

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

<!--[if !supportLists]-->8.&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]-->HISTÓRIA ESCOLAR: (considerar:
entrada precoce ou tardia na escola; &nbsp;trocas constantes de escolas; &nbsp;como se processou a alfabetização; dificuldades
da mãe para lidar com as exigências escolares)

Frequentou
creches? &nbsp;&nbsp;(&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Quando entrou para a escola
(idade): _______________________

Por
quê?_____________________________________________________________________________________________________________

Quem
escolheu a escola?________________________________________________________________________________________________

Como
foi essa escolha?__________________________________________________________________________________________________

Caso
tenha havido mudança, por que mudou?________________________________________________________________________________

_____________________________________________________________________________________________________________________

Repetiu
ano? (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N&nbsp;&nbsp; Por quê? ______________________________________________________________________________________

_____________________________________________________________________________________________________________________

Houve
problema com professor (es) (&nbsp;&nbsp;&nbsp; ) S&nbsp; (&nbsp;&nbsp;&nbsp; )
N

Qual?&nbsp;&nbsp;&nbsp; ______________________________________________________________________________________________________________

Como
é a atitude em sala de aula?

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Falta
muito à escola?&nbsp; (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp; &nbsp;&nbsp;) N

Por
quê? _____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Faz
reforço? &nbsp;(&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;Ele gosta do reforço? (&nbsp;&nbsp;&nbsp; ) S&nbsp;
(&nbsp;&nbsp;&nbsp; ) N&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Qual o motivo do
reforço?____________________________________

_____________________________________________________________________________________________________________________

O que
você acha da escola? (há uma abertura? um diálogo? ou é tradicional?)

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

A
filosofia da escola é Tradicional&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;&nbsp;&nbsp;
Comportamentalista&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;&nbsp;
Construtivista&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;&nbsp;
Sócio-construtivista&nbsp; (&nbsp;&nbsp;&nbsp;&nbsp; )&nbsp;&nbsp;
Outros:________________

<!--[if !supportLists]-->9.&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]-->FINALIZAÇÃO:

O que
você mais gosta nesse (a) filho (a)?

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

O que
você não gosta nele (a)?

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Orientação
aos Pais:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Observações:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Encaminhamento:
(Ao assinalar um ou mais itens, preencher abaixo os motivos que apontem as
necessidades).

(&nbsp;&nbsp;&nbsp; ) Psicólogo &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(&nbsp;&nbsp;&nbsp; )
Neurologista&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;(&nbsp;&nbsp;&nbsp; ) Fonoaudiologista&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(&nbsp;&nbsp;&nbsp; )
Oftalmologista&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(&nbsp;&nbsp;&nbsp;
) Otorrinolaringologista &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(&nbsp;&nbsp;&nbsp;
) Pediatra

(&nbsp;&nbsp;&nbsp; ) outros: ____________________________________________________________________________________________________________

Motivos:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________





Escólio
3:

&nbsp;Uma cópia dessa&nbsp; anamnese deve acompanhar o relatório de
encaminhamento ao profissional, bem como uma cópia da Queixa de origem e outros
históricos/pareceres solicitados, seus anexos e solicitada a devolutiva de
parecer para ajuntamento documental e tomadas resolutivas.







São Paulo, _____ de _____________________________de 20____________





_________________________________________________ 

Responsável pelo preenchimento (1) nome/cargo:



_________________________________________________

e/ou (2) nome/cargo:



_________________________________________________

Psicopedagogo(a)



_________________________________________________

Supervisão













Professor
Carlos E. Wolf (© 2014.8
- Direitos
Reservados)&nbsp;&nbsp;&nbsp; ceywolf@yahoo.com.br&nbsp;&nbsp;&nbsp; ceywolf.blogspot.com




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