FACULTAD DE CIENCIAS DE LA SALUDCARRERA FONOAUDIOLOGICA

Cuestionario a los Padres para el rango 2-3 aosI. Identificacin del PacienteNombre: _________________________________________________________________Edad: ________________________ Fecha de Nacimiento: _________________________Domicilio: ________________________________________________________________Escolaridad: _________________________________Nivel: ________________________Evaluador: ________________________________ Fecha de Evaluacin: ______________Datos Proporcionados por: ___________________________________________________

1. El nio llama la atencin de otra persona para mostrarle alguna accin u objeto._________________________________________________________________________________________________________________________________________________________________________________________________________________.

2. El nio saluda y comparte con personas conocidas_________________________________________________________________________________________________________________________________________________________________________________________________________________.

3. Narra experiencias de lo que le sucede en el jardn_________________________________________________________________________________________________________________________________________________________________________________________________________________.

4. Tiende a Aislarse y estar solo?_________________________________________________________________________________________________________________________________________________________________________________________________________________.

5. Teme a situaciones nuevas?__________________________________________________________________________________________________________________________________________________________________________________________________________________.

6. Juega con nios de su edad?____________________________________________________________________________________________________________________________________________________________________________________________________________________.

7. Espera que los otros nios le respondan?____________________________________________________________________________________________________________________________________________________________________________________________________________________.

8. Posee inters de comunicarse con otros?____________________________________________________________________________________________________________________________________________________________________________________________________________________.

9. Organiza acontecimientos sin ayuda?____________________________________________________________________________________________________________________________________________________________________________________________________________________.

10. Hace berrinches y rabietas frecuentemente?____________________________________________________________________________________________________________________________________________________________________________________________________________________.OBS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

________________________________ ___________________________________ Firma Padre/Madre/Tutor Fonoaudilogo(a)