CONSILIUL JUDEEAN ARAD

DIRECIA GENERAL DE ASISTEN SOCIAL

I PROTECIA COPILULUI
Str. 1 Decembrie 1918, nr. 14, cod 310134
tel./ fax. 0040 (0)257 210055, 210035
mobilphone: 0040 (0)745 534965; 0040 (0)735 203423
e mail: secretariat@dgaspc-arad.ro
web: www.dgaspc-arad.ro
Operator de prelucrare date cu caracter personal nr. 8089

ANAMNEZ

Nume i prenume:____________________________________________________________
Vrsta i sexul:_______________________________________________________________
Starea sntii actuale:________________________________________________________
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Antecedentele heredo-colaterale (boli somatice i psihice ale rudelor de gradul I i II)
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Mediul familial anterior:______________________________________________________
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Mediul familial actual (atmosfera familial):______________________________________
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Mediul social anterior i actual (cercul de prieteni):________________________________

Proprietatea Direcia General de Asisten Social i Protecia Copilului Arad; nu poate fi difuzat sau reprodus fr autorizare

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Nivelul de instruire:___________________________________________________________
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Date semnificative privind evoluia psihic pn la vrsta colar:____________________
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Date semnificative din perioada colar(succese, eecuri):___________________________
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Date legate de profesie (evoluie profesional, relaii cu colegii, sefii, promovri):_______
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Modul de petrecere a timpului liber:_____________________________________________
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Idealul n via, concepia general asupra vieii:__________________________________
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Proprietatea Direcia General de Asisten Social i Protecia Copilului Arad; nu poate fi difuzat sau reprodus fr autorizare