Você que faz acompanhamento ou atendimento particular especializado talvez precise de uma ferramenta que facilite o trabalho realizado com seu aluno, visando tornar mais prática essa ação montei esse esquema:
Área ________________________Profissional : ________________________________
Nome do aluno:___________________________________________________________
Nome da mãe:____________________________________________________________
Nome do pai:_____________________________________________________________
Data de nascimento: _____/______/________ Matrícula/Prontuário: ________________
Escola em que estuda: ______________________________________________________
Turno: ______________________ Turma:________________ Tel: ___________________
Frequência semanal do ano de __________ :
Distr. | Jan | Fev | Mar | Abr | Maio | Jun | Jul | Ago | Set | Out | Nov | DEZ |
1 Sem | ||||||||||||
2 Sem | ||||||||||||
3 Sem | ||||||||||||
4 Sem | ||||||||||||
5 Sem | ||||||||||||
Total |
Faltas totais: _________ (P= presente, F = falta FJ= Falta justificada)
Data da Entrevista: ____/____/____
Cid: ________________________
Resumo da anamnese:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Resumo e anotações de percepções e evoluções trimestrais:
I trimestre: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
II trimestre: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
II trimestre: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Observações:
Saiu da lista de atendimento por faltas [ ] - ____/_____/_____
Saiu da lista dos atendimentos por solicitação do responsável [ ] - _____/_____/_____
Remanejado para outro profissional [ ] Motivo: ________________________________
Encaminhamento interno para: Fono [ ] ; Fisio [ ] ; Psicólogo(a) [ ] ; Ed. Física [ ] ; T.O [ ]
Outra modalidade: [ ] ________________________
Mudança: No dia de atendimento: [ ] No turno [ ]
Outras observações: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Assistente social ciente: ____________________________
Data: _____/____/_________
