modello D.F.

DIAGNOSI FUNZIONALE
SEZIONE INFORMATIVA GENERALE

A. DATI ANAGRAFICI
Cognome________________________________ Nome__________________________________
Data di nascita ____________________________ Luogo di nascita _________________________
Residenza _______________________________ Indirizzo _______________________________
Telefono ________________________________ Altro recapito ___________________________
B. CURRICULO SANITARIO E RIABILITATIVO
notizie rilevanti sullo sviluppo del soggetto e sul suo percorso diagnostico-riabilitativo
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C. ALTRE INFORMAZIONI RITENUTE UTILI( ambito familiare e sociale )
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Pag. 1

AREA COGNITIVA
Sviluppo qualitativo del pensiero
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Memoria
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Attenzione e concentrazione
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Organizzazione visivo-spaziale e visivo-motoria
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Organizzazione temporale
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Strategie adottate e atteggiamenti rispetto al compito
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Sintesi rispetto alle difficolt e alle risorse
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Pag. 2

AREA LINGUISTICA E DELLA COMUNICAZIONE

Linguaggio verbale:
comprensione_____________________________________________________________________
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produzione_______________________________________________________________________
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Linguaggio scritto
lettura___________________________________________________________________________
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scrittura_________________________________________________________________________
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Linguaggio non verbale
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Sintesi rispetto alle difficolt e alle risorse
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Pag. 3

AREA AFFETTIVO-RELAZIONALE

Rapporto con se stesso

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Rapporto con gli altri
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Incidenza di fattori emotivi rispetto allapprendimento
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Sintesi rispetto alle difficolt e risorse
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Pag. 4

AREA SENSORIALE
Funzionalit visiva
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Funzionalit uditiva
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Funzionalit tattile/gustativa/olfattiva
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Sintesi rispetto alle difficolt e alle risorse
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Pag.5

AREA MOTORIO-PRASSICA
Motricit globale
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Coordinazione
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Motricit fine
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Schema corporeo
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Sintesi rispetto alle difficolt e alle risorse
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Pag.6

AREA DELL'AUTONOMIA
Autonomia della persona
( intesa come autonomia personale) vestirsi, alimentazione, igiene personale, ........
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Autonomia sociale
( intesa come autonomia funzionale al contesto sociale ) uso del denaro, dei mezzi di trasporto,
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Sintesi rispetto alle difficolt e risorse
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Sintesi diagnostica-funzionale
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firma___________________________
Data: __________________

Pag. 7