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NOMBRE Y APELLIDO:_______________________________________________________________________
DOMICILIO: ______________________________________________________________________________
TELÉFONO:_____________________
ESCUELA:_________________________________________________________________________________
DIAGNOSTICO: ____________________________________________________________________________
OCUPACION DE LOS
PADRES:_________________________________________________________________________________
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OBSERVACIONES:
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ANTECEDENTES PERINATALES:
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1
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ANTECEDENTES HEREDITARIOS:
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¿COMO LO CALMABA?______________________________________________________________________
DESARROLLO PSICOMOTOR:
CUANDO LO TENIA EN BRAZOS, ¿UDS SENTIAN QUE ERA “MUY FLOJITO” O DEMASIADO
“RÍGIDO”?________________________________________________________________________________
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2
CONTROL DE ESFINTERES:___________________________________________________________________
¿ES ATENTO?_____________________________________________________________________________
¿TUVO JUEGO
SIMBÓLICO?______________________________________________________________________________
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3
¿ARMA FRASES?
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ESCOLARIDAD:
¿PUEDE INTERARCTUAR?
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¿CÓMO SE COMPORTA?
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¿RESPETA A LA MAESTRA?
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CONDUCTA:
¿RESPETA LÍMITES?
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¿OBEDECE ÓRDENES?
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¿HACE BERRINCHES?
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¿CÓMO LO TRANQUILIZÁS?
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4
¿TIENE PROBLEMAS CON LA COMIDA?
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LENGUAJE ACTUAL:-
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¿SE LE ENTIENDE CON FACILIDAD?:-
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LATERALIDAD:_____________________________________________________________________________
LECTURA Y
ESCRITURA:_______________________________________________________________________________
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SOCIAL:
PERSONALIDAD:___________________________________________________________________________
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CONDUCTA:______________________________________________________________________________
TOLERANCIA A LA FRUSTRACION:_____________________________________________________________
¿LLORA MUCHO?:__________________________________________________________________________
¿OBEDECE?_______________________________________________________________________________
¿TIENE AMIGOS?__________________________________________________________________________
¿DEMUESTRA EMOCIONES?__________________________________________________________________
INTERESES:_______________________________________________________________________________
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PARTICIPA EN CONVERSACIONES
FAMILIARES:______________________________________________________________________________
5
¿CÓMO ES UN DIA DEL
NIÑO?___________________________________________________________________________________
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Postura:
o General:_________________________________________________
o En situaciones de lectoescritura:______________________________
Respiración:
Tipo:__________________________________________________
Modo:_________________________________________________
Voz:__________________________________________________________
Deglución:_____________________________________________________
Lenguaje actual
o Reducción del lenguaje espontáneo:___________________________
o Simplificación de la sintaxis: _________________________________
o Errores gramaticales: _______________________________________
o Anomias:_________________________________________________
o Pobreza de vocabulario: ____________________________________
o Comprensión alterada: ______________________________________