ANAM N E S I S

Fecha actual___________________________________________________________________
Nombre: ______________________________________________ Sexo: __________________
Edad: _____ a. _____ m. Fecha Nacimiento: _________________ Escolaridad: _____________
Escuela: ______________________________________________________________________
Informante: ___________________________________________________________________
ENFERMEDAD ACTUAL:
Sntomas actuales:__________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Desde cuando: ____________________________________________________________________
Primeros tratamientos______________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
HISTORIA FAMILIAR
Lugar de origen____________________________________________________________________
Datos del padre__________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Datos de la madre__________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Hermanos:_______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Parientes que sufran enfermedades_________________________________________________

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Dinmica familiar (estilo de crianza, castigos, engreimientos, etc)_______________________

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

NIEZ:
Tipo de nio: timido ( )

agresivo ( )

Obediente

rebelde ( )

( )

retrado

( )

juguetn

( )

caprichoso ( )

_____________________________________________________________________________
_____________________________________________________________________________
Datos de evolucin_____________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Datos de desarrollo psicosomtico y neurolgico____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
EDUCACIN:
Edad en que fue al colegio, inters escolar, estudios culminados, problemas de aprendizaje, etc.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Repitencias (veces, razn y reacciones): ____________________________________________

_____________________________________________________________________________
_____________________________________________________________________________
Problemas relacionados a su aprendizaje, audicin, visin, parlisis, etc____________________
_____________________________________________________________________________
_____________________________________________________________________________
Antecedentes de salud psicolgica: ________________________________________________
_____________________________________________________________________________

TRABAJO
Primer trabajo__________________________________________________________
Otros trabajos___________________________________________________________
______________________________________________________________________
______________________________________________________________________
CAMBIOS DE RESIDENCIA
______________________________________________________________________
______________________________________________________________________
ACCIDENTES Y ENFERMEDADES
Accidentes que ha sufrido
______________________________________________________________________
______________________________________________________________________
Enfermedades que haya padecido
______________________________________________________________________
______________________________________________________________________
Tuvo enfermedades venreas?_____________________________________________
______________________________________________________________________

VIDA SEXUAL
Conocimientos sobre sexualidad___________________________________________
______________________________________________________________________
Masturbacin___________________________________________________________
______________________________________________________________________
Primeras relaciones______________________________________________________
______________________________________________________________________
Matrimonio_____________________________________________________________
______________________________________________________________________
Hijos__________________________________________________________________
______________________________________________________________________
HBITOS E INTERESES
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
ACTITUDES PARA CON LA FAMILIA
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
ACTITUD FRENTE A LA ENFERMEDAD
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
SUEOS
______________________________________________________________________
______________________________________________________________________

Observaciones
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____________________________________________________________________________.