ANAMNESIS

Fecha actual 29/09/17

Nombre: Virginia Indalicia Romero Rojas Sexo: F
Edad: 60 a. 4 m. Fecha Nacimiento: 15/05/1957 Escolaridad: Superior
Informante: Virginia Indalicia Romero Rojas
ENFERMEDAD ACTUAL:
Sntomas actuales:__________________________________________________________________
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Desde cundo: ____________________________________________________________________

Primeros tratamientos______________________________________________________________
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HISTORIA FAMILIAR

Lugar de origen____________________________________________________________________
Datos del padre__________________________________________________________________
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Datos de la madre__________________________________________________________________
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Hermanos:_______________________________________________________________________
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Parientes que sufran enfermedades_________________________________________________

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Dinmica familiar (estilo de crianza, castigos, engreimientos, etc) _______________________
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NIEZ:

Tipo de nia: tmida ( ) agresiva ( ) retrada ( ) juguetona ( )

Obediente ( ) rebelde ( ) caprichosa ( )

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Datos de evolucin_____________________________________________________________
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Datos de desarrollo psicosomtico y neurolgico____________________________________

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EDUCACIN:

Edad en que fue al colegio, inters escolar, estudios culminados, problemas de aprendizaje, etc.
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Repitencias (veces, razn y reacciones): ____________________________________________

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Problemas relacionados a su aprendizaje, audicin, visin, parlisis, etc____________________
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Antecedentes de salud psicolgica: ________________________________________________

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TRABAJO
Primer trabajo__________________________________________________________
Otros trabajos___________________________________________________________
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CAMBIOS DE RESIDENCIA
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ACCIDENTES Y ENFERMEDADES
Accidentes que ha sufrido
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Enfermedades que haya padecido
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Tuvo enfermedades venreas?______________________________________________
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VIDA SEXUAL
Menstruacin___________________________________________________________
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Conocimientos sobre sexualidad____________________________________________

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Masturbacin___________________________________________________________
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Primeras relaciones_______________________________________________________
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Matrimonio_____________________________________________________________
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Hijos__________________________________________________________________
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HBITOS E INTERESES
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ACTITUDES PARA CON LA FAMILIA
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ACTITUD FRENTE A LA ENFERMEDAD

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SUEOS
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Observaciones
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