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7/23/2019 Ficha Psicologica Adultos
http://slidepdf.com/reader/full/ficha-psicologica-adultos 1/2
FICHA PSICOLÓGICAADULTOS
I. DATOS PERSONALES
Nombres y Apellidos: ____________________________Edad: _____ Nivel de Instrucción: ____________ Ocupación: ______________
Lugar y fecha de Nacimiento: _______________________ Numero de hermanos: _______ Domicilio: _______________________
Estado civil: ____________________ Nmero de hi!os: _______ "el#fono: _______________ $echa de Evaluación: ________________
II. MOTIVO DE CONSULTA (problema ac!al"
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
III. O#SERVACION DE CONDUCTA
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
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IV. ANTECEDENTES (#re%e &'or'a pero)al"
"ipo de hogar%%%%%%%%%%%&&' creció al cuidado de%%%%%%&&%%%%%%%%%&' (rea laboral%%%%%%% '
ocupación del padre%%%%%%%ocupación de la madre%%%%%%%&%&&' vinculación afectiva%%%%%%%%%%%%&&%'
desempe)o escolar%%%%%%%%%%%%%&&&' antecedentes de enfermedades* accidente u hospitali+ación %%%%%%%%&&&'
En sus ratos libres se dedica a%%%%%%%%&&&&&&&&&Antecedente de algn tipo de violencia ,f-sica* se.ual* psicológica/: %%%%&%&*
por %%%%%%%%%& 0onducta de riesgo actual o como antecedente%%& ,Alcohol* drogas* intentos suicidas* promiscuidad*
pandillas/%%%%%%%&&%%%&%%%%%&&"erapia psicológica o psi1ui(trica anterior%%%%%%%%%%%%%%%%%&%&
* Ob. _______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
V. T+CNICAS O INSTRUMENTOS UTILI,ADOS
VI. CONCLUSIONES-
VII. RECOMENDACIONES-
2sic& 3andy 2astor 4osales
E3"E DO056EN"O 0A4E0E DE 7ALO4 LE8AL
7/23/2019 Ficha Psicologica Adultos
http://slidepdf.com/reader/full/ficha-psicologica-adultos 2/2E3"E DO056EN"O 0A4E0E DE 7ALO4 LE8AL
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