Nr____/______________

FI PSIHOLOGIC
Nume________________________ Prenume____________________________Vrsta______
Tipul de dizabilitate____________________________________________________________
Dizabiliti asociate____________________________________________________________
Dezvoltarea senzorial-perceptiv________________________________________________
Nivelul dezvoltrii psiho-motricitI______________________________________________
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Nivelul de dezvoltare intelectual ( Vrsta de dezvoltare, Coeficient de dezvoltare)_______
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Testul/ proba psihologic_______________________________________________________
I. Gndirea (inclusiv nivelul operaional),____________________________________
____________________________________________________________________________
II. Memoria _____________________________________________________________
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III. Atenia______________________________________________________________
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Imaginaie___________________________________________________________________
Limbaj i comunicare__________________________________________________________
____________________________________________________________________________
Afectivitatea__________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Motivaia_____________________________________________________________________
Temperament_________________________________________________________________
Voina_______________________________________________________________________
Atitudini_____________________________________________________________________
Aptitudini____________________________________________________________________
Nivelul maturizrii psiho-sociale_________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Cabinet Individual de Psihologie Leah Elena

Tulburri clinice:______________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Tulburri de personalitate/retard mintal: __________________________________________
Condiii medicale generale______________________________________________________
Probleme psihosociale i mediu_________________________________________________
Probleme cu grupul de suport principal_____________________________________
Probleme n legatur cu mediul social_______________________________________
Probleme educaionale___________________________________________________
Probleme profesionale____________________________________________________
Probleme cu locuina_____________________________________________________
Probleme economice_____________________________________________________
Probleme n legtur cu accesul la serviciile medicale_________________________
Probleme legate de interaciunea cu sistemul legal____________________________
Alte probleme psihosociale i de mediu_____________________________________
Funcionarea global________________________________________________________
Profilul psihologic__________________________________________________________
____________________________________________________________________________
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____________________________________________________________________________
____________________________________________________________________________
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____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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Recomandari psihologice ___________________________________________________
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Data

Psiholog

Cabinet Individual de Psihologie Leah Elena