HISTORIA CLÍNICA PSICOLÓGICA.

ANAMNESIS
I.

Datos de Filiación:
• Nom. y Apell._____________________________________________________________________:
• Sexo
: ____________ Edad :___________ Fecha de Nac.___________________:
• Lugar de Nac._________________________________:
Procedencia_______:
• Dirección
: ______________________________________ Télf:________________________
• Grado de Inst.________________________________:
Religión_______________:
• Estado Civil : ______________________________ Ocupación_________________________:
• Padre
: __________________________________________ Edad:____________________
• Madre
: __________________________________________ Edad:____________________
• Referente
: ______________________________________________________________________
• Informantes : ______________________________________________________________________
• Lugar de Eval.____________________________________________________________________:
• Fechas de Eval.___________________________________________________________________:
• Examinador : Psicólogo Jorge Luis Fernández Salguero.

II. Motivo de Consulta:
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III. Historia de la Enfermedad o del problema actual:
A. Tiempo:
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B. Forma de Inicio:
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C. Síntomas Principales:
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D.Relato:
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Etapa Post-Natal:  Primer Año: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________  Desarrollo Neuro-Psicomotor: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ . Antecedentes Clínicos: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ IV. Antecedentes Personales: A.____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ E. Etapa Natal: “Parto” ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ C. Etapa Pre-natal: “Embarazo o gestación” ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ B.

Servicio Militar: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I. Religión: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ J. Enfermedades y accidentes: ____________________________________________________________________________________ .Actividad Laboral: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ H. Historia de la Recreación y de la vida: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ L. Sexo Femenino): __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________  Aspecto psicosexual y Matrimonio: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ G. Hábitos e influencias nocivas o tóxicas: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ K. Desarrollo y Función Sexual:  Aspectos Fisiológicos: (Sexo masculino.Rasgos Neuropáticos: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ E. Etapa Escolar: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ F.D.

ocupación): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ D. Composición Familiar: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ B. Dinámica Familiar (Hábitos. Antecedentes Familiares: A. Resumen: _______________________________________________________________________________________ .Antecedentes Patológicos: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ VI.____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ M. ubicación sociocultural. Personalidad Premórbida: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ V. Condición Socioeconómica (vivienda. costumbres): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ C. condiciones sanitarias.

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ .

________________________________: Procedencia_______: • Dirección : ______________________________________ Télf:________________________ • Grado de Inst. lugar. Lenguaje: (Ritmo. contenido) _______________________________________________________________________________________ . tono. Actitud Porte y Comportamiento: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ III. Atención. Datos de Filiación: • Nom. espacio. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ IV. persona y personas). Conciencia y Orientación: Atención y Concentración: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Conciencia o Estado de Alerta: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Orientación: (Tiempo. y Apell. II.____________________________________________________________________: • Fechas de Eval._______________________________: Religión_______________: • Estado Civil : ______________________________ Ocupación_________________________: • Padre : __________________________________________ Edad:____________________ • Madre : __________________________________________ Edad:____________________ • Referente : ______________________________________________________________________ • Informantes : ______________________________________________________________________ • Lugar de Eval.EXÁMEN PSICOLÓGICO O MENTAL I._____________________________________________________________________: • Sexo : ____________ Edad :___________ Fecha de Nac.___________________________________________________________________: • Examinador : Psicólogo Jorge Luis Fernández Salguero.___________________: • Lugar de Nac.

Memoria: (Corto y largo plazo) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ VIII. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Pensamiento: Razonamiento y Juicios ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ IX. Pensamiento: (Curso y contenido) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ VI. Percepción: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ VII. Estado de Ánimo y Afectos: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ X. Funcionamiento Intelectual: Conocimientos Generales. Comprensión y Grado de Incapacidad del Problema o Enfermedad: _______________________________________________________________________________________ . ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Memoria._______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ V.

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ XI. Resumen: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ .

y Apell.____________________________________________________________________: • Fechas de Eval. II. Datos de Filiación: • Nom. I._____________________________________________________________________: • Sexo : ____________ Edad :___________ Fecha de Nac.___________________________________________________________________: • Examinador : Psicólogo Jorge Luis Fernández Salguero.INFORME PSICOMÉTRICO.___________________: • Lugar de Nac._________________________________: Procedencia_______: • Dirección : ______________________________________ Télf:________________________ • Grado de Inst.________________________________: Religión_______________: • Estado Civil : ______________________________ Ocupación_________________________: • Padre : __________________________________________ Edad:____________________ • Madre : __________________________________________ Edad:____________________ • Referente : ______________________________________________________________________ • Informantes : ______________________________________________________________________ • Lugar de Eval. Interpretación de los instrumentos: _______________________________________________________________________________________ . Instrumentos Utilizados: ψ ψ ψ ψ ψ ψ ψ IV. Observaciones Generales: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ III.

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ V. Resumen: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _____________________________ Fernández Salguero Jorge Luis Psicólogo .

y Apell._________________________________: Procedencia_______: • Dirección : ______________________________________ Télf:________________________ • Grado de Inst. II. Técnicas e instrumentos Utilizados: ψ Observación._____________________________________________________________________: • Sexo : ____________ Edad :___________ Fecha de Nac.___________________: • Lugar de Nac. ψ Historia Clínica. ψ Pruebas Psicométricas _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ IV. ψ Entrevista.___________________________________________________________________: • Examinador : Psicólogo Jorge Luis Fernández Salguero. Datos De Filiación: • Nom.INFORME PSICOLÓGICO I. Antecedentes Personales y Familiares: _______________________________________________________________________________________ .________________________________: Religión_______________: • Estado Civil : ______________________________ Ocupación_________________________: • Padre : __________________________________________ Edad:____________________ • Madre : __________________________________________ Edad:____________________ • Referente : ______________________________________________________________________ • Informantes : ______________________________________________________________________ • Lugar de Eval.____________________________________________________________________: • Fechas de Eval. Motivo de Consulta: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ III.

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ V. _______________________________________________________________________________________ . Observaciones Conductuales.

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ VI. Pronóstico. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ VII. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ IX.Diagnóstico o Conclusión. Recomendaciones: ψ ___________________________________________________________________________________ ψ ___________________________________________________________________________________ ψ ___________________________________________________________________________________ ψ ___________________________________________________________________________________ ψ ___________________________________________________________________________________ ψ ___________________________________________________________________________________ ψ ___________________________________________________________________________________ ψ ___________________________________________________________________________________ ψ ___________________________________________________________________________________ ψ . Análisis e Interpretación de los Resultados. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ VIII.

________________________________: Religión__________: • Estado Civil : ______________________________ Ocupación____________________: • Padre : __________________________________________ Edad:_______________ • Madre : __________________________________________ Edad:_______________ • Referente : _________________________________________________________________ • Informantes : _________________________________________________________________ • Lugar de Eval. Datos de Filiación: • Nom.______________: • Lugar de Nac. II.______________________________________________________________: • Examinador : Psicólogo Jorge Luis Fernández Salguero. y Apell.________________________________________________________________: • Sexo : ____________ Edad :___________ Fecha de Nac. Diagnóstico Psicológico: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ III.PLAN PSICOTERAPEÚTICO I. Técnicas Terapéuticas: ψ ψ ψ ψ ψ ψ ψ ψ . Objetivos Generales: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ IV. Objetivos Específicos: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ V._________________________________: Procedencia__: • Dirección : ______________________________________ Télf:___________________ • Grado de Inst._______________________________________________________________: • Fechas de Eval.

Actividades Psicoterapéuticas: SESIÓ N TÉCNICAS REALIZADAS “ P R I M E R A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ SESIÓ N TÉCNICAS REALIZADAS “ S E G U N D A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ SESIÓ N TÉCNICAS REALIZADAS “ T E R C E R A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ .VI.

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SESIÓ N TÉCNICAS REALIZADAS “ C U A R T A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ SESIÓ N TÉCNICAS REALIZADAS “ Q U I N T A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ SESIÓ N TÉCNICAS REALIZADAS “ S E X T A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ .

SESIÓ N TÉCNICAS REALIZADAS “ S E P T I M A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ SESIÓ N TÉCNICAS REALIZADAS “ O C T A V A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ SESIÓ N TÉCNICAS REALIZADAS “ N O V E N A ” Objetivos Acciones Especificas ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ SESIÓ N TÉCNICAS REALIZADAS “ Objetivos ” Acciones Especificas ____________________________ ___________________________________________________ .

Tiempo de Ejecución: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ VIII. Avances y Logros Terapéuticos: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Arequipa de del 2010 .VII.

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