Download - Anamneza Adult
ANAMNEZA
Nume si prenume: ___________________________________________________________
Data nasterii/varsta: __________________________________________________________
Sex: ____
Anamneza familial
Tatăl:
Vârsta: _____
Starea sănătăţii: ___________________________________________________________
Ocupaţia: _______________________________________________________________
Personalitatea: _________________________________________________________
Calitatea relaţiilor cu pacientul: ____________________________________________
Mama:
Vârsta: _____
Starea sănătăţii: ___________________________________________________________
Ocupaţia: _______________________________________________________________
Personalitatea: __________________________________________________________
Calitatea relaţiilor cu pacientul: _____________________________________________
Fraţii:
Nume: ___________________________
Vârstă: _________
Stare civilă: ________
Ocupaţie: _________
Personalitate: ___________________________________________________________
Afecţiuni psihice: _______________________________________________________
Calitatea relaţiilor cu pacientul: _____________________________________________
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Poziţia socială a familiei (atmosfera în casă):
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Afecţiuni mintale în familie:
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Datele personale
Sarcină şi naşteri:
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Primele faze ale dezvoltării:
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Starea sănătăţii în copilărie:
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„Probleme nervoase” în copilărie: (spaime, accese de furie, timiditate, balbism,
înroşirea feţei, capricii alimentare, somnambulism, enurezis, coşmaruri frecvente)
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Şcolarizare:
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Istoricul ocupaţional:
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Istoricul menstruaţiei:
Vârsta menarhei: ____________________________
Atitudinea faţă de menstruaţie: ___________________________________________________
Vârsta menopauzei (simptome): ___________________________________________________
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Istoricul cuplului:
Vârsta în momentul căsătoriei: __________________________________________________
Durata relatieie înainte de căsătorie şi durata logodnei: ________________________________
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Alte detalii: _________________________________________________________________
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Copiii:
Nume: ___________________________
Sex: _________
Vârstă: _________
Temperament: _________________
Dezvoltare afectivă: ___________________________________________________________
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Sănătate fizică şi mintală: ________________________________________________________
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Calitatea relatiilor cu pacientul: __________________________________________________
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Probleme medicale anterioare (afecţiuni, operaţii, accidente):
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Afecţiuni psihice anterioare (natura şi durata afecţiunilor, evoluţie):
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Condiţii de viaţă actuale:
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Relaţii: prietenii puţine
multe
superficiale
strânse
Folosirea timpului liber: pasiuni
curiozităţi
Dispoziţia predominantă:
Descriptiv:
Observational:
Caracter:
Descriptiv:
Observational:
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Atitudini şi norme:
moral şi religios:
atitudine faţă de sănătate şi faţă de propriul corp:
Obiceiuri:
Mâncare:
Alcool:
Tutun:
Medicamente:
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