Documentos de Académico
Documentos de Profesional
Documentos de Cultura
1. Datos de Identificación:
Nombre_________________________________________________________
Edad _______________________Cédula _____________________________
Estado Civil ______________
Escolaridad_______________Ocupacion______________________________Do
micilio________________________________________________________Telefo
no________________ Derivación _______________________________
Fecha ____________________Terapeuta______________________________
3. Genograma
4. Observaciones
A) Queja inicial
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
F) SOLUCIONES INTENTADAS
1. Por el paciente identificado _______________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
___________________________________________
2. Por los otros __________________________________________
_______________________________________________________
_______________________________________________________
______________________________________________
3. Exitosas _____________________________________________
_______________________________________________________
_________________________________________________
Se mantuvieron____________________________________________________
________________________________________________________________
No se mantuvieron _________________________________________________
___________________________________________________________________
_____________________________________________________________
¿Porque fueron abandonadas? ______________________________________
___________________________________________________________________
___________________________________________________________________
__________________________________________________________
9. MOTIVACION
A) ¿Qué objetivos busca al consultar? ___________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
10.DIAGNOSTICO _____________________________________________
____________________________________________________________
____________________________________________________________
______________________________________________________
14.PREDICCIONES
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________
15.ESTRATEGIAS A SEGUIR
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________
______________________________
Profesional - Firma