UNIVERSIDAD DE SUCRE VERSIÓN:

PÁG: 1
PLAN DE VISITA DOMICILIARIA FECHA
PLA. PS -004

FACULTAD PROYECTO_____________________________________

No. de Visita__________________
Fecha: _______________________Familia______________________________________
Nombre del Paciente (usuario)_______________________________________________
Dirección________________________________________________________________

Objetivo de la Visita
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Factor o problemática a intervenir:

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Actividades a realizar en el día de la Visita

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Estrategia a implementar para lograr orientar a la familia para que tenga una visión
positiva, acerca de sus dificultades y como poder superarlas
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Educación Planeada: Tema de la sesión educativa (anexar plan de sesión)

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Ayudas educativas a utilizar:

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EVALUACIÓN:

Resultados de la visita (comentarios en términos de logros, dificultades)

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Evaluación del avance que ha tenido la familia:

Factores: Valoración:

Rojo (Retroceso)
Amarillo (No avance)
Verde (Avance)

Compromisos:
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Aspectos a tratar en la próxima visita

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Responsable de la Visita ___________________________________________________:

Copia Controlada_______ No .________Copia no Controlada No.______________