Documente Academic
Documente Profesional
Documente Cultură
I. Date personale
Numele copilului
________________
Data naşterii________________
Locul naşterii _______________
Adresa
__________________________________________________________________________
Grădiniţa/şcoala ________________
Tatăl _________________
vârsta________________
ocupaţia ______________
Mama________________
vârsta _________________
ocupaţia________________
I. Situaţia familială
Fraţi ________________
Surori ________________
Alţi membri ai familiei care locuiesc cu copilul
__________________________________________________________________________
Antecedente patologice:
• boli _____________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
primele simptome ___________________________________________________________
• istoricul bolii ____________________________________________________________
• internări:
- vârsta _________________
- motivul __________________________________________________________________
- unde ____________________________________________________________________
- tratament ________________________________________________________________
_________________________________________________________________________
V. Dezvoltarea limbajului
Repere:
- lalaţiunea ____________________
- primele silabe _____________________________________________________________
- primele cuvinte ____________________________________________________________
- primele propoziţii __________________________________________________________
- nivelul vocabularului ________________________________________________________
- înţelegerea limbajului/ limbaj receptiv
__________________________________________________________________________
__________________________________________________________________________
- scrierea
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
- citirea
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
- dificultăţi de pronunţie
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
• cogniţie
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
• comunicare
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
• socializare
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
• situaţia şcolară
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
• diagnostic
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
VII. Consemnări în convorbirile cu părinţii
• Activităţi preferate
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
• Activităţi dezagreate
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
• Jucării preferate
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
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VIII. Concluzii, recomandări:
• Nevoile copilului şi recomandarea P.I.P.
Tipul de asistenţă recomandat
• Recomandări speciale:
- consultaţii de specialitate
- recomandări curriculare
IX.