HISTORIA OCUPACIONAL

NOMBRE: ________________________________________________________________________
RUT: ______________________FECHA DE NACIMIENTO: ________________EDAD:____________
1. Hbitos y rutinas cotidianas
Laborales
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Fin de semana
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Actividades de la vida diaria.
AVDB
Higiene__________________________________________________________________________
Vestuario________________________________________________________________________
Alimentacin_____________________________________________________________________
Descanso________________________________________________________________________
Salud___________________________________________________________________________
AVDI
Cuidado espacio personal___________________________________________________________
Cuidado casa_____________________________________________________________________
Cuidado de otros__________________________________________________________________
Cocina___________________________________________________________________________
Ropa____________________________________________________________________________
Comunicacin_____________________________________________________________________
Transporte_______________________________________________________________________
Manejo de dinero__________________________________________________________________

AVDA
Manejo tiempo____________________________________________________________________
Gestiones en la comunidad__________________________________________________________
Mantenimiento hogar______________________________________________________________
Autonoma
___Autonoma econmica y funcional
___Autonoma funcional y dependencia econmica
___Autonoma econmica y dependencia funcional
2. Roles de vida
Familia
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Relaciones Sociales
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Trabajo y Estudios
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3. Tiempo Libre y Proyectos
Uso del tiempo libre
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Satisfaccin
___Muy satisfecho
___Algo satisfecho
___Ni satisfecho ni insatisfecho. Indiferente.

___Insatisfecho
Ocio
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Intereses
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___Deportivas
___Culturales
___Ldicas/Recreativas
___Sociales
___Relacionadas con tecnologas de la informacin y comunicacin
Proyectos
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4. Desempeo Habilidades
Sensoriomotoras
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Cognitivas
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Interaccin y Comunicacin

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5. Entorno
Entorno Fsico
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Entorno Socio-Familiar
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Entorno Productivo
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Entorno de Tiempo Libre
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6. Acuerdos Teraputicos
ACUERDOS

HBITOS Y
RUTINAS

REVISIN

REVISIN

REVISIN

ROLES DE
VIDA

TIEMPO LIBRE
Y PROYECTOS

DESEMPEO
DE
HABILIDADES

ENTORNO