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ANAMNESIS FONOAUDIOLÓGICA

I. Antecedentes personales

a. Nombre: ____________________________________________________________________________

b. Fecha de Nacimiento: _________________________________________________________________

c. Edad: __________________________________________________________________________________

d. Curso: _______________________________________________________________________________

e. Colegio: _____________________________________________________________________________

f. Motivo de consulta:
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g.Antecedentes del desarrollo:

i. Periodo pre, peri y postnatal:


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ii. Motor:
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iii. Lingüístico:

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iv. Psicoafectivo:

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h. Antecedentes del grupo familiar:


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i. Antecedentes mórbidos

i. Del niño:
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ii. De la familia:
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j. Fecha de la evaluación fonoaudiológica:


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k. Evaluaciones y tratamientos fonoaudiológicos previos:


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l. Malos hábitos
orales:_______________________________________________________________________________________
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m. Antecedentes escolares: (rendimiento escolar en lgje., mat.; promedio de


notas)________________________________________________________________________________________
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n. Otros antecedentes, observaciones:

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