Historia Psicológica
Historia Psicológica
Historia Psicológica
“DESARROLLO ESCOLAR”
HISTORIA PSICOLÓGICA
I. DATOS GENERALES
Apellidos y Nombres: --------------------------------------------------------------------------------------
Fecha de Nacimiento: -------------------------- Lugar de Nacimiento: ------------------------------
Edad: ----------------- Grado: --------------- Sección: ---------------- Turno: --------------------------
Número de Hermanos: --------------------------- Lugar que Ocupa: --------------------------------
Estado Civil de los Padres: --------------------------------------------------------------------------------
Nombre de la Madres: ------------------------------------------------------------------------------------
Grado de Instrucción: --------------------------------------------------------------------------------------
Nombre del Padre: -----------------------------------------------------------------------------------------
Grado de Instrucción: --------------------------------------------------------------------------------------
Referido por: -------------------------------------------------------------------------------------------------
Responsable: ------------------------------------------------------------------------------------------------
Fecha: ---------------------------------------------------------------------------------------------------------
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Desarrollo cronológico de los síntomas:
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Antecedentes de Consulta, Hospitalización y/o Tratamiento psicológico.
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Patológica Familiar -------------------------------------------------------------------------------------
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III: HISTORIA PERSONAL
A) DESARROLLO INICIAL:----------------------------------------------------------------------------------------
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B) ESCOLARIDAD: --------------------------------------------------------------------------------------------------------
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UNIVERSIDAD CÉSAR VALLEJO | LIMA ATE
Carretera Central Km.8.2, Ate Vitarte
Telf. 2009030 Anexo: 8645
PROGRAMA:
“DESARROLLO ESCOLAR”
C) C) RELACIONES INTERPERSONALES: -----------------------------------------------------------------------------
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D) D) HISTORIA DE ENAMORAMIENTO/ SEXUALIDAD: ---------------------------------------------------------
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E) E) INTERESES Y ACTIVIDADES:-------------------------------------------------------------------------------------
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Ambiente Familiar:
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V. DIAGNÓSTICO:
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VI. RECOMENDACIONES:
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ENTREVISTA PSICOLÓGICA
Académico (Rendimiento)
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Emocional:
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Social:
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Familiar:
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IV: SINTOMAS:
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VII: RECOMENDACIONES:
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