INFORME PSICOLOGICO

I. DATOS GENERALES

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 Edad
 Sexo
 Fecha de Nacimiento
 Lugar de Nacimiento
 Grado de Instrucción
 Ocupación
 Informante
 Lugar de Residencia
 Fecha de Evaluación
 Examinador
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II. MOTIVO DE CONSULTA

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III. TECNICAS Y PRUEBAS APLICADAS

- observación
- entrevista
- pruebas psicológicas:

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IV. ANTECEDENTES FAMILIAES Y PERSONALES

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V. INTERPRETACION DE LOS RESULTADOS.

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VI. DIAGNOSTICO PRESUNTIVO

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VII. RECOMENDACIONES
- psicoterapia psicológica individual
- psicoterapia familiar
- terapia de relajación
- Orientación y consejería en temas de adolescencia

MOQUEGUA, ______________________

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 PLAN PSICOTERAPEUTICO
I. DATOS GENERALES

 Apellidos y Nombres : __________________________________

 Edad : _________________________________
 Sexo : _________________________________
 Fecha de Nacimiento : _________________________________
 Lugar de Nacimiento : _________________________________
 Grado de Instrucción : _________________________________
 Ocupación : _________________________________
 Informante : _________________________________
 Lugar de Residencia : _________________________________
 Fecha de Evaluación : _________________________________
 Examinador : _________________________________

II . IMPRESIÓN DIAGNOSTICA.
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III. OBJETIVOS GENERALES

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IV. TECNICAS PSICOTERAPEUTICAS.

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V. AVANCES TERAPEUTICOS
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VI. TIEMPO DE EJECUSION

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VIII. OBJETIVOS ALCANZADOS

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 INFORME PSICOLOGICO
I.- DATOS GENERALES

 Apellidos y Nombres : __________________________________

 Edad : _________________________________
 Sexo : _________________________________
 Fecha de Nacimiento : _________________________________
 Lugar de Nacimiento : _________________________________
 Grado de Instrucción : _________________________________
 Ocupación : _________________________________
 Informante : _________________________________
 Lugar de Residencia : _________________________________
 Fecha de Evaluación : _________________________________
 Examinador : _________________________________

II. MOTIVO DE CONSULTA

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III. TECNICAS E INSTRUMENTOS PSICOLOGICOS UTILIZADOS

- Observación
- Entrevista
- Examen mental

IV.OBSERVACIONES GENERALES Y DE CONDUCTA

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V. PROBLEMA ACTUAL
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VI. ANTECEDENTES PERSONALES Y FAMILIARES

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VII. ANALISIS E INTERPRETACION DE RESULTADOS

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VIII. IMPRESIÓN DIAGNOSTICA
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IX. RECOMENDACIONES

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