![Page 1: Ficha de identificacion para expedientes clinicos](https://reader035.vdocuments.pub/reader035/viewer/2022062401/58eceac81a28ab32138b478b/html5/thumbnails/1.jpg)
UNIVERSIDAD DE MONTEMORELOSFacultad de Psicología
Teorías y técnicas de la entrevista
FICHA DE IDENTIFICACIÓN
NOMBRE: _______________________________________________________________________
Fecha de nacimiento: __________________ Edad: ______________
Ocupación: ________________
Religión: ____________________________
FECHA DE REGISTR0 TRO DE CITA: ____ /____ /____
MOTIVO DE CONSULTA Y DESCRIPCIÓN DEL PROBLEMA ACTUAL:
OBSERVACIONES:
![Page 2: Ficha de identificacion para expedientes clinicos](https://reader035.vdocuments.pub/reader035/viewer/2022062401/58eceac81a28ab32138b478b/html5/thumbnails/2.jpg)
GENOGRAMA:
ANTECEDENTES PERSONALES Y FAMILIARES:
RECOMENDACIONES:
REFERIDO A: ____________________________
OBSERVACIONES:
![Page 3: Ficha de identificacion para expedientes clinicos](https://reader035.vdocuments.pub/reader035/viewer/2022062401/58eceac81a28ab32138b478b/html5/thumbnails/3.jpg)
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
TERAPEUTA:_________________________________