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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

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