SCOALA SPECIALA NR .

1 CONSTANTA
Comisia de evalu ar e comple x a si rep ar tiz ar e
______________
a elevilor

Clas a
Re gi m _____________

FISA DE EXAMINARE A COPILULUI

LA INTRAREA IN SCOALA

I . Dat e g e n e r a l e
Numel e de familie __________________________ pren u m e l e
________________________
nascu t in anul __________ luna ________ ziua _______ locul nas t e rii ______________
____________________________________Domiciliul _________________________________
________________________________________________________________________________
Fam ili a :
Numel e parintilor : tat a __________________________
nation alit a t e a _______________
varst a __________ studii ___________________________ ocup a ti a
____________________
locul de munc a _______________________________________________________________ .
ma m a _______________________ nation alit a t e a
_______________
varst a __________ studii __________________________ ocup a ti a
____________________
locul de munc a _______________________________________________________________ .
Motiv u l trimit e rii :
Trimis de __________________________________________________________________
Diagno s tic _________________________________________________________________
Nivel intelect u al ____________________________________________________________
Deficient e asocia t e __________________________________________________________

II . Ana m n e z a :
A . FAMILIALA
Al catel e a copil est e ______________ star e a de san a t a t e a me m b rilor familiei
_______
__________________________________ pers o a n e cu tulbur a ri de limbaj in familie
____
__________________ ( intre parti ) _________________________________ ( fata de copil
)
___________________________________________________________________.
B . PERSONALE
Sarcina _______________________ Naster e a la ter m e n

/ la _____________ luni .

Date asu pr a limbajului:

Pronu n tia _________________________ Vorbire a : lalatiun e a ______________ primele
cuvint e ____________________________ propozitii _________________________ star e a
actu al a ________________________________________________________________________
ritmul vorbirii
__________________________________________________________________
intele g e r e a vorbirii pers o a n el o r din jur
__________________________________________
A ben eficiat de trat a m e n t logop e dic
_____________________________________________

III . Exam e n so m a t i c si fun c t i o n a l

Aspect som a tic :
Configur a ti a capului ______________________ cavita t e a toracic a
___________________
____________________ me m b r el e
_________________________________________________
cavita t e a bucal a ___________________________________ val palatin
_________________
______________________ limba _________________________ buzele
___________________
maxilar el e __________________________________________ dentitia
__________________
________________________________________________________________________________
Functia auditiva :______________________________________________________________
1. Motricitat e a
_________________________________________________________________
2. Mersul ______________________________________________________________________
3. Later alita t e a ________________________________________________________________
IV . Niv el d e Pre g a t i r e :
La ce scoala a mai fost _______________________________ clas a
____________________
cuno a s t e literele _____________________________________
cites t e literele ________________________________________
silab el e _______________________________________
cuvint e ________________________________________
Scrie dup a dictar e literele ____________________________________________
silab el e ____________________________________________
cuvint e _____________________________________________
Poves t e s t e
_____________________________________________________________________
Vocab ul ar ul ___________________________________________________________________
Cunoa s t e cifrele _____________________________ nu m a r a
__________________________
Aspect e ale ad a p t a rii psiho - sociale
Este sociabil _________________________________________
Are deprind e ri de autos e r vir e ________________________________________
Se desc urc a in me diul cunos c u t _____________________________________
Propu n e rile comisiei :

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Semn a t u r a me m b rilor comisiei :

_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
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