FICHA DE ATENCION PSICOLOGICA ALUMNO PIE.

Nombre
Rut
Fecha de Nacimiento
Edad
Escolaridad
Establecimiento Nombre de la
institución
Dirección
Teléfono
Profesor (a)Jefe

PERSONA A CARGO
Nombre
Parentesco
Dirección
Teléfono
Ocupación

MOTIVO DE CONSULTA
 GENOGRAMA

HISTORIAL DEL ALUMNO (Anamnesis).

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ANTECEDENTES FAMILIARES.

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AREA COGNITIVA Y AFECTIVA.

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AREA SOCIAL Y CONDUCTUAL

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 INTERVENCIONES ANTERIORES
Farmacoterapia
Psicoterapia
Intervención
Social
Otras
Intervenciones

PLAN DE TRABAJO
Tipo de Atención Trabaja Individual
Trabajo Grupal
Trabajo con Padres
Trabajo Familiar

Responsable de la evaluación y tratamiento psicológico: