Date generale despre copil din plasament

Date despre copii

Numele-______________________________________________________________
Prenumele____________________________________________________________
Data nașterii__________________________________________________________
Adresa copilului _______________________________________________________

Date despre părinți / îngrijitori

Mama
Numele, prenumele _____________________________________________________
Telefon de contact ______________________________________________________
Tata
Numele , prenumele _____________________________________________________
Telefon de contact _______________________________________________________

Alte persoane de contact ( buneii)

Numele , prenumele ______________________________________________________
Telefon de contact ________________________________________________________
Instituția ( grădinița/ școala ) pe care o frecventează copilul
Adresa _________________________________________________________________
Numele , prenumele educatorului/ pedagogului, telefon de contact __________________
________________________________________________________________________
Instituția medicală la evidența căreia se află copilul, adresa ________________________
_________________________________________________________________________
Numele, porenumele medicului curant, telefon de contact___________________________
_________________________________________________________________________
Istoric
social_________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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_____________________________________________________________________________

Persoana de contact din cadrul serviciului APP

Funcția __________________________________________________________________
Numele __________________________________________________________________
Prenumele _______________________________________________________________
Adresa , telefon de contact __________________________________________________
Informație importantă despre copil
Regimul zilnic
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Regimul săptămînal
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Particularitățile de comportament
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Regimul alimentar
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Igiena personală
_____________________________________________________________________________
_____________________________________________________________________________
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_____________________________________________________________________________
Particularități de sănătate
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Administrarea medicamentelor
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Preferințele copilului
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Evidența plasamentelor
De la __________________pănă la __________________în total zile ____________________
De la __________________ pînă la __________________ în total zile ____________________
De la ___________________ pînă la _________________ în total zile ____________________
De la ___________________ pînă la _________________ în total zile ____________________
De la ___________________ pînă la _________________ în total zile ____________________
De la ___________________ pînă la _________________ în total zile ____________________
De la ___________________ pînă la _________________ în total zile ____________________
De la ___________________ pînă la _________________ în total zile ____________________
De la ___________________ pînă la _________________ în total zile ____________________