Sunteți pe pagina 1din 2

Consiliul Judetean Salaj

Directia Generala de Asistenta Sociala si Protectia Copilului Salaj Sef centru


Complexul de Servicii Sociale nr.2 Jibou Pop Claudia Ronela
Centrul de Abilitare sis Reabilitare Jibou
Str, Stejarilor, nr. 173/A

Fisa individuala

Nume/prenume_____________________________

Diagnostic _______________________________________________________

Data evaluarii___________________

Situatia familiala:

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Comportament social

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Date privind evolutia beneficiarului

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Consiliul Judetean Salaj
Directia Generala de Asistenta Sociala si Protectia Copilului Salaj Sef centru
Complexul de Servicii Sociale nr.2 Jibou Pop Claudia Ronela
Centrul de Abilitare sis Reabilitare Jibou
Str, Stejarilor, nr. 173/A

Evaluare medicala

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Evaluare psihologica

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Evaluare kinetoterapie

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Evaluare ergoterpie

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

S-ar putea să vă placă și