Entrevisrta psicologica

ENTREVISTA PSICOLOGICA

                                                                   Fecha:__________________________

FICHA DE IDENTIFICACION

Nombre_________________________________________________ Edad__________

Fecha y lugar de nacimiento_______________________________________________

Dirección______________________________________________________________

Estado civil_____________ Escolaridad_______________________________

Ocupación________________Religión_____________

DESCRIPCION DEL PACIENTE

Aspectos generales, características físicas

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Vestimenta

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Porte y actitud (modales)

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Movimientos. Voz y lenguaje

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Afecto

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MOTIVO DE CONSULTA

Historia del problema

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Clase de ayuda que espera encontrar

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Historial del conflicto (clínica)

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SITUACION ACTUAL

Descripción de un día de vida. Especificar cambios particulares en los fines de semana

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CONSTELACION FAMILIAR

Antecedentes patológicos

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Descripción de madre y padre

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Relación padres paciente

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Hermanos

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Papel del paciente dentro de la familia

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Uniones y fricciones dentro de la familia

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Normas sociales, culturales, morales y religiosas dentro de la familia

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Cambios en la constelación familiar (abandono, divorcio, muertes etc.)

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RECUERDOS TEMPRANOS

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HISTORIA PERSONAL

Embarazo y nacimiento

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Inicio de marcha, habla y control de esfínteres

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Infancia

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Adolescencia

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Edad adulta

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Edad avanzada

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SALUD

Alimentación

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Sueño

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Enfermedades

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Lesiones, operaciones

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Que opina de su salud actualmente

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ESCOLARIDAD

Escuelas a las que asistió, cuando y que grado alcanzó

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