A N A M N E S I S

A N A M N E S I S

Fecha actual___________________________________________________________________Nombre: ______________________________________________ Sexo: __________________Edad: _____ a. _____ m. Fecha Nacimiento: _________________ Escolaridad: _____________Escuela: ______________________________________________________________________Informante: ___________________________________________________________________

ENFERMEDAD ACTUAL:Sntomas actuales:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Desde cuando: ____________________________________________________________________

Primeros tratamientos______________________________________________________________________________________________________________________________________________________________________________________________________________________________

HISTORIA FAMILIARLugar de origen____________________________________________________________________

Datos del padre________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Datos de la madre________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Hermanos:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Parientes que sufran enfermedades______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dinmica familiar (estilo de crianza, castigos, engreimientos, etc)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

NIEZ:

Tipo de nio: timido ( ) agresivo ( ) retrado ( ) juguetn ( )

Obediente ( ) rebelde ( ) caprichoso ( )

__________________________________________________________________________________________________________________________________________________________

Datos de evolucin_______________________________________________________________________________________________________________________________________________________________________________________________________________________

Datos de desarrollo psicosomtico y neurolgico________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EDUCACIN:

Edad en que fue al colegio, inters escolar, estudios culminados, problemas de aprendizaje, etc.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Repitencias (veces, razn y reacciones): ______________________________________________________________________________________________________________________________________________________________________________________________________

Problemas relacionados a su aprendizaje, audicin, visin, parlisis, etc______________________________________________________________________________________________________________________________________________________________________________

Antecedentes de salud psicolgica: _____________________________________________________________________________________________________________________________

TRABAJOPrimer trabajo__________________________________________________________Otros trabajos_______________________________________________________________________________________________________________________________________________________________________________________________________

CAMBIOS DE RESIDENCIA____________________________________________________________________________________________________________________________________________

ACCIDENTES Y ENFERMEDADESAccidentes que ha sufrido____________________________________________________________________________________________________________________________________________Enfermedades que haya padecido____________________________________________________________________________________________________________________________________________

Tuvo enfermedades venreas?___________________________________________________________________________________________________________________

VIDA SEXUALConocimientos sobre sexualidad_________________________________________________________________________________________________________________Masturbacin_________________________________________________________________________________________________________________________________Primeras relaciones____________________________________________________________________________________________________________________________Matrimonio___________________________________________________________________________________________________________________________________Hijos________________________________________________________________________________________________________________________________________

HBITOS E INTERESES________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ACTITUDES PARA CON LA FAMILIA________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ACTITUD FRENTE A LA ENFERMEDAD________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SUEOS____________________________________________________________________________________________________________________________________________

Observaciones__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.