Anamnese Infanto-Juvenil (MODELO)
Anamnese Infanto-Juvenil (MODELO)
Anamnese Infanto-Juvenil (MODELO)
Data: ____________
Queixa Principal:
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Reforçadores em potencial:
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Esportes: ( ) S ( ) N
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Verbal: ( ) S ( ) N
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Interage bem: ( ) S ( ) N
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Olha no olho ao ser chamado: ( ) S ( ) N
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Seletividade alimentar: ( ) S ( ) N ______________________________________________
Dorme bem: ( ) S ( ) N _______________________________________________________
Brinca com função: ( ) S ( ) N
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Sabe o seu nome: ( ) S ( ) N
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Sabe as vogais: ( ) S ( ) N _____________________________________________________
Sabe as cores: ( ) S ( ) N ______________________________________________________
Sabe o alfabeto: ( ) S ( ) N
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Sabe os numerais: ( ) S ( ) N
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Sabe o nome dos responsáveis: ( ) S ( ) N
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Resistência com algum material: ( ) S ( ) N
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Atende a comandos: ( ) S ( ) N
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Estereotipia: ( ) S ( ) N
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Ecolalia: ( ) S ( ) N
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Fixação: ( ) S ( ) N
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Dificuldade motora: ( ) S ( ) N
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Identifica as partes do corpo: ( ) S ( ) N
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Sensibilidade: ( ) S ( ) N
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Resistência a algo: ( ) S ( ) N
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Gosta de música: ( ) S ( ) N
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Fala inglês: ( ) S ( ) N
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Nomeia as cores? ( ) S ( ) N o
Nomeia objetos? ( ) S ( ) N
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Identifica Figuras? ( ) S ( ) N
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Assiste desenho animado? ( ) S ( ) N
Quais? ______________________________________________________________________
Nomeia animais? ( ) S ( ) N
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Sabe as emoções? ( ) S ( ) N
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Sabe se expressar? ( ) S ( ) N
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Auto-agressão: ( ) S ( ) N
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Agressivo com os outros: ( ) S ( ) N
Em quais momentos?
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Gosta de animais? ( ) S ( ) N
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Usa Fralda? ( ) S ( ) N
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Em caso de não usar fralda, sabe pedir para ir ao banheiro? ( ) S ( ) N
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Sabe se vestir sozinho? ( ) S ( ) N
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Sabe comer só? ( ) S ( ) N
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É uma criança desastrada? ( ) S ( ) N
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Tem autonomia para fazer o que?
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Tem noção de perigo? ( ) S ( ) N
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Outras observações:
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