O Material Psicopedagógico

ANAMNESE – Jovens e adultos.

Data entrevista inicial _____/______/________

1. Identificação

Nome:____________________________ _______________

Idade:_________Nasc.:____/____/____ Sexo:___________ Cor:_______________

Naturalidade:______________________Nacionalidade:_______________________

Grau de instrução:_____________________________________________________

Profissão:_____________________________Estado Civil:_____________________

Religião:___________________________________Praticante (  )sim (   )não

Fones pra contato:___________________________________________________________________________________

2. Queixa Principal

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3. História da doença atual (sintoma, época que iniciaram cronologicamente, providencia tomada de medicamentos)

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4. História Pessoal

Concepção (desejada, planejada, abortos naturais, provocados)

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Gestação (enjôo, vômito, traumatismo físico/psíquico, pré-natal, infecções ou doenças)

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Parto (descrição, posição do nascimento, fórceps, cesariana, normal, prematuro, a termo, local e condições, apgar e 1ªs reações do bebê)

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Sintomas neuróticos na infância (medos, terror noturno, sonambolismo, gagueira, enurese noturna, condutas impulsivas, agressão, fuga, chupar dedo, mamadeira, tiques, roer unhas, fala dormindo,... idades)

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