EVALUARE PSIHOLOGICA

DATE PERSONALE:
 Nume, Prenume...........................................................................................................................
 Varsta, starea civila.....................................................................................................................
 Ocupatie......................................................................................................................................

AMAMNEZA ...................................................................................................................
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COMPORTAMENT SI FUNCTII PSIHICE
Comportament...........................................................................................................................
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Orientare spatio-temporala......................................................................................................

Factor perceptiv.........................................................................................................................

Memorie.....................................................................................................................................
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Atentie.....................................................................................................................................................
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Gandire si inteligenta................................................................................................................
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Limbaj....................................................................................................................................................
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Obsesii / convulsii.....................................................................................................................
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Depersonalizare / derealizare.................................................................................................
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Dispozitie afectiva....................................................................................................................
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Constiinta bolii / reprezentarea mentala a bolii si capacitatea de apreciere a
situatiei...................................................................................................................................................
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8. DIAGNOSTIC DSM IV
 Axa I (tulburari clinice): ........................................................................................................
 Axa II (tulburari de personalitate, deficienta mintala): ......................................................
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 Axa III (boli somatice sau alte conditii medicale): ...............................................................
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 Axa IV (stresori psihosociali):................................................................................................
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 Axa V (indicele general de functionare - GAF):...................................................................

CONCLUZII:.........................................................................................................................................
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RECOMANDARI

DATA EVALUARII PSIHOLOG