Академический Документы
Профессиональный Документы
Культура Документы
FICHA INDIVIDUAL
Proc.
N:___________
Motivo do
pedido:______________________________________________________________
Pedido feito
por:_______________________________________________________________
IDENTIFICAO
Nome do aluno:
________________________________________________________________
Morada:
______________________________________________________________________
Telefone: _______________________
e-mail:
_______________________________________
Data de nascimento:____________________________________
Idade:______________
Naturalidade:_______________________________________________________________
___
Escola que frequenta: _______________________________________
________
Pgina 1 de 8
Ano:
Local de
trabalho:_______________________________________________________________
AGREGADO FAMILIAR
Quantos so?___________
Nome/Grau de
parentesco
Escolaridade
Profisso/Ocupao
Idade
HISTRIA FAMILIAR
Me:________________________________________________________________________
_
Idade: _____ Hab. Literrias: ____________________ Profisso:
_________________
Naturalidade:_________________________________________
Estado
Civil:_________
Morada:_____________________________________________________________________
_
Cont. Telef:_________________________ email:_________________________________
Pai:
__________________________________________________________________________
Idade: _____ Hab. Literrias: ___________________
_
Profisso:
_________________
Naturalidade:_________________________________________
Estado
Civil:_________
Morada:_____________________________________________________________________
_
Cont. Telef:_________________________ email:_________________________________
N. de Irmos:__________
Nome
Escolaridade
Ocupao
Idade
Pgina 2 de 8
_____________________________________________________________________________
_____________________________________________________________________________
Problemas psicolgicos especficos em familiares:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
SITUAO ESCOLAR/PROFISSIONAL
Histria pr-escolar e escolar (contextos frequentados, como creche, jardim
de infncia, av, amas, n de repetncias, adaptaes e primeiras reaces,
):
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Escola/Instituio que
frequenta:__________________________________________________
Curso:_____________________________________________________________
Ano:_______
Horrio:_____________________________________________________________________
_
Situao
profissional:___________________________________________________________
Quantos empregos teve?______________ Porque saiu?
_______________________________
Funes
desempenhadas:________________________________________________________
Contextos de socializao e actividades frequentados (cinema, dana,
escuteiros, ginsio, ):
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Pgina 3 de 8
HISTRIA PESSOAL
Gravidez: Planeada?_____ Acidental?______Desejada?______ Ass. Mdica?
_______________
(pr-natal)
Problemas/doenas no decorrer da gravidez; se teve acompanhamento por
parte do pai da criana; testes realizados; medicao; consumo de lcool,
tabaco, cafena, outras drogas, ;
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Problemas/doenas maternos ou paternos:
_____________________________________________________________________________
_____________________________________________________________________________
Descrever o estado psico-emocional ao longo da gravidez:
_____________________________________________________________________________
_____________________________________________________________________________
(pri-natal)
Parto:
____________________________________________Complicaes:________________
Ouviu de imediato o choro do beb?__________ Dias de
hospitalizaes:__________________
(ps-natal)
Amamentao? _______________At que idade? __________ 1s passos (idade):
__________
HISTRIA DESENVOLVIMENTAL
Linguagem (idade das 1s palavras e outras caract); controle esfincteriano;
rotina e hbitos do sono e do adormecer; problemas alimentares:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Problemas de sade:
Convulses
Quedas
Insolao
Meningite
Sarampo
Papeira
Varicela
Rubola
Hepatite
Otites
Pediatra/mdico
assistente:______________________________________________________
Pgina 4 de 8
Infece
s
?
Pgina 5 de 8
_____________________________________________________________________________
_____________________________________________________________________________
Relao com os vrios familiares (irmos, tios, avs, ):
_____________________________________________________________________________
_____________________________________________________________________________
Relao com outros adultos:
_____________________________________________________________________________
_____________________________________________________________________________
Descrever o relacionamento mais significativo:
_____________________________________________________________________________
_____________________________________________________________________________
H dificuldades de relacionamento? Quais?
_____________________________________________________________________________
_____________________________________________________________________________
Descrio de um dia (com quem se cruza, como se sente, ):
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Drogas (cafena, lcool, lsd, ervas, cogumelos mgicos,)
Experincia com drogas?_____________ Quais?
______________________________________
Freq.:____________________________ Sente-se viciada/o?
____________________________
Pgina 6 de 8
CARACTERIZAO DO PEDIDO
Aspectos preocupantes para os pais (inicio); comportamentos
problemticos:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Histria do problema actual:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
O que j foi feito para tentar resolver:
Recurso a outros servios (locais, datas de exames mdicos ou psicolgicos
efectuados, )
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Opinio dos outros acerca desses problemas (educadora, professora,
colegas, famlia, )
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Observaes:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Pgina 7 de 8
_____________________________________________________________________________
Pgina 8 de 8