HISTORIA CLINICA ESTUDIANTE
Enviado por MARILU876 • 5 de Julio de 2016 • Apuntes • 354 Palabras (2 Páginas) • 169 Visitas
BIENESTAR UNIVERSITARIO[pic 1][pic 2]
DEPARTAMENTO DE PSICOLOGÍA
HISTORIA CLINICA ESTUDIANTE
Psicólogo __________________Enfoque ___________________Área ___________________
Dirección ___________________ Teléfonos _________________ Ciudad _________________
Institución _______________________________________ Fecha _________________________
- DATOS PERSONALES
Nombre _____________________________________ Sexo ___________________________
Fecha y lugar de nacimiento ________________________________ Estado civil __________
Nivel educativo ______________ Profesión ________________ Ocupación _______________
Religión ________ Hijo(s) _____ Lugar de residencia ___________ Estrato ___________
Dirección _______________________Barrio _______________ Teléfonos ________________
Eps ______________ Email _____________________________
DATOS CONTACTO
Nombre _______________________________________________________________________
Lugar de residencia ___________________ Dirección_ _________________________________
Teléfonos __________________ Parentesco ________________ ________________________
OBSERVACIONES
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- MOTIVOS DE CONSULTA
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- SINTOMATOLOGIA ASOCIADA
Emocional
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Mental
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Físico
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Sentido
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RELATO PSICOGENOSOCIOGRAMA
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ORDEN EMOCIONAL
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AREA PERSONAL
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¿En qué áreas o vivencias de tu vida no eres feliz?
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ANALISIS DE PAREJA
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