INFORME PSICOLGICO

I. DATOS GENERALES
. Nombres y Apellidos : ..
. Edad : ..
. Sexo : F M
. Fecha de nacimiento : ..
. Lugar de nacimiento : ..
. Nmero de hermanos : ..
. Lugar entre hermanos : ..
. Domicilio : ..
. Telfono : ..
. Grado de instruccin : ..
. Estado civil : ..
. Fecha de evaluacin : ..
. Entrevistador : ..

II. MOTIVO DE CONSULTA

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III. PROBLEMA ACTUAL

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IV. ANTECEDENTES (Datos relevantes)
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V. TECNICAS E INSTRUMENTOS UTILIZADOS

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VI. RESULTADOS
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VII. DIAGNSTICO FUNCIONAL

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VIII. DIAGNSTICO MULTIAXIAL
Eje I: _____________________________________________________________________
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Eje II: ____________________________________________________________________
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Eje III: ____________________________________________________________________
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Eje IV: ____________________________________________________________________
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Eje V: ____________________________________________________________________
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IX. PRONSTICO
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X. RECOMENDACIONES
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*SE DEBE EMITIR INFORME PSICOLGICO CUANDO EL PACIENTE CUENTE CON

INSTRUMENTOS EVALUADOS. EL NMERO DE INFORMES QUE EL SUPERVISOR
REVISE EN EL CENTRO DE PRCTICAS, DEBER CORRESPONDER AL NMERO DE
INFORMES SOLICITADOS POR EL ASESOR Y ACORDE A LAS DIRECTIVAS DADAS POR
LA COORDINACIN DE PRCTICAS PRE PROFESIONALES.