Cooperativa para el Desarrollo Integral del Niño

“COOPDIN”
NIT. 800.150.236-6
CONVENIO ALCALDIA DE NEIVA-SECRETARIA DE EDUCACIÒN

HISTORIA CLINICA

AREA DE FONOAUDIOLOGIA

Fecha de valoración_______________________________________ R.C/T.I___________________

DATOS PERSONALES:

Nombres:_______________________________Apellidos:_________________________________

F.N.__________________________________Edad:___________Sexo:______ (m)______(F)_____

Seguridad social:_______________________ Lateralidad: D.______________ I.______________

Dirección:_________________________________________TEL:___________________________

Diagnostico Medico: ______________________________________________________________

ANTECEDENTES FAMILIARES:

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ANTECEDENTES PERSONALES:

PRE_NATALES:____________________________________________________________________
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PERI_NATALES:____________________________________________________________________
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POST_NATALES:___________________________________________________________________
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DESARROLLO PSICOMOTOR:

DESARROLLO MOTOR:
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DESARROLLO DEL LENGUAJE: O.F.A (Balbuceo, vocalizaciones, primeras palabras)

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Calle 6 # 12-21Barrio Altico – Neiva

Email: coopdin@hotmail.com
Tel. 8757627
 Cooperativa para el Desarrollo Integral del Niño
“COOPDIN”
NIT. 800.150.236-6
CONVENIO ALCALDIA DE NEIVA-SECRETARIA DE EDUCACIÒN

ALIMENTACION:___________________________________________________________________
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PERCEPCION VISUAL-AUDITIVA:

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PROCESO DE LECTO-ESCRITURA:

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COMUNICACIÓN ACTUAL:

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ESCOLARIDAD: (inicio, adaptación y rendimiento):

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TRATAMIENTOS RECIBIDOS:

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VALORACION:

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Calle 6 # 12-21Barrio Altico – Neiva

Email: coopdin@hotmail.com
Tel. 8757627
 Cooperativa para el Desarrollo Integral del Niño
“COOPDIN”
NIT. 800.150.236-6
CONVENIO ALCALDIA DE NEIVA-SECRETARIA DE EDUCACIÒN

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DIAGNOSTICO Y CONDUCTA:

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FONOAUDIOLOGA

Calle 6 # 12-21Barrio Altico – Neiva

Email: coopdin@hotmail.com
Tel. 8757627