Download - ANAMNESIS-FONOAUDIOLOGICA
ANAMNESIS FONOAUDIOLÓGICA
I. Antecedentes personalesa. Nombre: ____________________________________________________________________________b. Fecha de Nacimiento: _________________________________________________________________c. Edad: __________________________________________________________________________________d. Curso: _______________________________________________________________________________e. Colegio: _____________________________________________________________________________f. Motivo de consulta:
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g. Antecedentes del desarrollo:i. Periodo pre, peri y postnatal:
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ii. Motor: __________________________________________________________________________________________________________________________________________________________
iii. Lingüístico:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
iv. Psicoafectivo:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
h. Antecedentes del grupo familiar: __________________________________________________________________________________________________________________________________________________________________________________________
i. Antecedentes mórbidosi. Del niño:
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ii. De la familia:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
j. Fecha de la evaluación fonoaudiológica: _____________________________________________________________________________________________
k. Evaluaciones y tratamientos fonoaudiológicos previos: _____________________________________________________________________________________________
l. Malos hábitos orales:____________________________________________________________________________________________________________________________________________________________________________________
m. Antecedentes escolares: (rendimiento escolar en lgje., mat.; promedio de notas)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
n. Otros antecedentes, observaciones:__________________________________________________________________________________________________________________________________________________________________________________________