INFORME DE EVALUACIÓN FONOAUDIOLÓGICO

1. ANTECEDENTES GENERALES

Nombre del Alumno:

Fecha de Nacimiento: Edad: Rut:

Antecedentes familiares:
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Antecedentes anamnésicos relevantes:

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2. ANTECEDENTES DE LA ATENCIÓN FONOAUDIOLÓGICA

2.1 Fecha de Evaluación:

2.2 Instrumento(s) de Evaluación aplicado(s):
TEST PUNTAJE DESVIACIÓ PUNTAJE PERCENTI RANGO DE
TOTAL N FINAL L EDAD
STANDARD
TEPROSIF-R
STSG (REC)
STSG (EXP)
TECAL V
M
S
TOTAL
OTROS

2.3 Síntesis Ficha fonoaudiológica

Habilidades Prelingüísticas:____________________________________________________________
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Habilidades Prearticulatorias:___________________________________________________________
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Órganos Fonoarticulatorios: ____________________________________________________________
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Praxias Bucolinguofaciales: ____________________________________________________________

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Audición: __________________________________________________________________________
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Voz: ______________________________________________________________________________
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Habla: ____________________________________________________________________________
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2.4 Descripción de las conductas lingüísticas del menor en relación a los siguientes
aspectos:

Fonético - Fonológico: ________________________________________________________________

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Semántico: _________________________________________________________________________
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Morfosintáctico:_____________________________________________________________________
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Pragmático: ________________________________________________________________________
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 2.5 Observaciones:

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3 RESULTADOS DE LA EVALUACIÓN:
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4 DIAGNÓSTICO FONOAUDIOLÓGICO:
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5 INDICACIÓN
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6 DERIVACIÓN
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7 FECHA DE INFORME:_______________________________________________________

8 FECHA DE REEVALUACIÓN:_________________________________________________

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Loreto Cortés Rodríguez
Fonoaudióloga
Universidad de Valparaíso
N° Secreduc 3523