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Republika e KosovësRepublika Kosova-Republic of Kosovo

Qeveria –Vlada-GovernmentMinistria e Punës dhe Mirëqenies Sociale

Ministarsvo Rada i Socijalne ZastiteMinistry of Labour and Sociale Welfare

Departamenti i Politikave Sociale dhe Familjes / Departamenat Socijalne Politike i

Porodicu / Department for Social and Family Policy

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KONFIDENCIALE/ CONFIDENTIAL/ POVERLJIVO

Profil i fëmijës/ Child profile/ Profil deteta

Fëmijë potencial për adoptim vendor/ Potential child for local adoption/ Potencijalno dete za lokalno usvojenje

Të dhënat e fëmijës / Data of Child / Podaci o detetu:

Emri/ Name/ Ime: ____________________________________

Data e Lindjes/Date of Birth/ Datum Rodjenja: ____________________________________

Gjinia/ Gender/ Rod: Femër/Female/Zensko

Mashkull/ Male / Musko

QPS/ CSW/ CSR: ____________________________________

Menaxheri i Rastit/ Case Manager/ Menadzer slucaja: ____________________________________

Nr.Tel/ tel. No./ Br.Tel: ____________________________________

Kujdestari ligjor/Legal guardian/Legalni staratelj: ____________________________________

Nr.Tel/ tel. No./ Br.Tel: ____________________________________

Fotografia e fëmijës / Photo of the Child / Slika deteta

Përshkrimi i shkurtër i fëmijës dhe nevojave te tij/ saj / Short description of the child and the needs of his/her Kratak opis deteta i njegove potrebe / njene

Rekomandime për rastin e fëmijës / Recommendations for child case / Preporuke za slučaj deteta

QPS/CSW/CSR:

Psikologu/ Psychologist / Psiholog:

Mjeku specialist / Specialist doctor/ L ekar specijalista:

Dokumentacioni I bashkëngjitur / A ttached documents / Dokumentacija u prilogu :

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