ENTREVISTA INICIAL ADULTOS DCA

FECHA EVALUACIÓN: _________

NOMBRE:
APELLIDOS:
FECHA NACIMIENTO:
NIVEL ESTUDIOS:
PROFESIÓN:

MOTIVO DE CONSULTA
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INFORMES QUE APORTA
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ENFERMEDADES/MEDICACIÓN
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DESCRIPCIÓN DE UN DÍA DE SU VIDA
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AHORA_____________________________________________________________
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COMPAÑÍA/CUIDADOR
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AUDICIÓN
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VISIÓN
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ALIMENTACIÓN
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RESPIRACIÓN
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VOZ
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LENGUAJE
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HABLA
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COMPRENSIÓN
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¿CÓMO DESCRIBIRÍA SU ATENCIÓN?
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¿CÓMO DESCRIBIRÍA SU PERSONALIDAD? tranquila, agresiva, pasiva, activa,
impulsiva…
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