Documente Academic
Documente Profesional
Documente Cultură
ANAMNESIS
Nombre:___________________________________________________________
Edad: ________________ Lugar y Fecha de Nacimiento: ____________________
Sexo: ________ Grado y sección: _______ Domicilio: ______________________
Teléfono: __________ Edad del Padre: ___________ Escolaridad: ____________
Ocupación: ___________ Religión: ____________ Edad de la Madre: _________
Escolaridad:_____________ Ocupación: __________
Estado Civil de los Padres: _________________ Referido por: _______________
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1
Periodo Prenatal (antecedentes de embarazo, TX. Y control prenatal, reacción de
los padres)
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Desarrollo Neuropsíquico
2
Desarrollo Motor (camino, gateo, salto, pintó).
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3
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4
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Firma del Entrevistador (a)