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AntetNou

Pentru eliberarea legitimatiei de transport urban gratuit

Pentru eliberarea legitimatiei de transport urban gratuit cu mijloace de transport in comun de suprafata pentru persoanele cu handicap (adulti/copii) sunt necesare :

-       o fotografie tip legitimatie (persoana cu handicap) ;

-       copie CI/BI ;

-       copie certificat de incadrare in grad de handicap valabil.

 

Pentru eliberarea legitimatiei de transport urban gratuit cu mijloace de transport in comun de suprafata pentru asistent personal sunt necesare :

-       o fotografie tip legitimatie (asistent personal) ;

-       copie CI/BI ;

-       copie certificat de incadrare in grad de handicap valabil.

  

Pentru eliberarea legitimatiei de transport CFR pentru persoanele cu handicap sunt necesare :

-       o fotografie tip legitimatie (persoana cu handicap) ;

-       copie CI/BI ;

-       copie certificat de incadrare in grad de handicap valabil.

Formular fisa Psihologica

FISA PSIHOLOGICA

 

Nume .............…………………….... Prenume ...……………............ Data nasterii ............…………

Tipul de dizabilitate ..………………………………….....................................................…………………………………….

Dizabilitati asociate .................................…………………………………......................……………………………………..

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Dezvoltarea senzorial – perceptiva ......................................…………………………...………………………………………..

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Nivelul dezvoltarii psiho-motricitatii ....................................……………………………..…………………………………….

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Nivel de dezvoltare intelectuala (varsta de dezvoltare, coeficient de dezvoltare) - se precizeaza testul/proba psihologica folosita)

I. Gandirea (inclusiv nivelul operational) .......................…………………………...........……………………………………..

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II. Memoria ..............................................................……………………………………..……………………………………..

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III. Atentia .........................................................…………………………………….........…………………………………….

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Nivelul I de cunoastere

Imaginatia ..............................................……………………………………...................………………………………………

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Limbajul si comunicarea ...................................................……………………………...………………………………………

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Afectivitate .....................................................……………………………………............……………………………………..

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Motivatie ..........................................……………………………………..........................……………………………………..

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Temperament ...........................................………………………………........................……………………………………….

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Vointa .......................................…………………………………….................................……………………………………...

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Atitudini ...................................................………………………………………...............……………………………………..

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Aptitudini .....................................................……………………………………..............……………………………………...

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Nivelul maturizarii psihosociale ................................……………………………............……………………………………...

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Profilul psihologic ......................................…………………………………....................……………………………………..

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Recomandari psihologice ...................................……………………………..................………………………………………

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Data completarii…………….                                                                           Psiholog, 

Fisa privind traseu-educational

Dosar nr. ______________

Data inregistrarii ________

Numele profesorului/psihopedagogului _______________

Sef serviciu _____________________________________

  

                                                FISA PRIVIND TRASEUL EDUCATIONAL

 

Nume ___________________ Prenume __________________________ Varsta _______

Gradinita/Scoala _________________________________Grupa/Clasa ______________

Adresa _________________________________________________________________

Promovat : da/nu

 

Programe prescolare la varsta prescolara(gradinite, centre de zi cu componenta educationala s.a.). Se vor preciza denumirea institutiei, tipul programului, rezultatele obtinute, s.a. _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Pregatirea scolara. Se  vor preciza : denumirea institutiei/institutiilor, tipul sau tipurile de scolarizare, rezultatele obtinute, s.a. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Activitati (inclusiv extrascolare) de sprijin anterioare si prezente ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Aprecieri asupra comportamentului in timpul activitatilor scolare anterioare si prezente ________________________________________________________________________________________________________________________________________

I. Atentia _______________________________________________________________

II. Motivatia de invatare __________________________________________________

III.Receptivitate de invatare _______________________________________________

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IV. Participare si implicare(pentru diferite tipuri de scolarizare) ________________

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V. Relatii sociale reciproce(cu colegii, cu profesorii, cu personalul auxiliar din scoala) ________________________________________________________________________________________________________________________________________________

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Aprecieri asupra modului de pregatire a lectiilor elevului (cu sprijin/fara sprijin) ________________________________________________________________________________________________________________________________________________

 

Comportamentul in afara scolii ________________________________________________________________________________________________________________________________________________

Recomandari pentru forme de scolarizare a copilului(se bifeaza) :

                        - gradinita

                        - gradinita speciala

                        - scoala generala

                        - scoala generala cu profesor de sprijin

                        - scoala generala cu curriculum adaptat

                        - scoala speciala

                        - scolarizare la domiciliu

                        - frecventa redusa in grupa sau clasa speciala compacta in scoala generala

                        - alte servicii/programe educationale _______________________

Data completarii fisei _______________

Semnatura ________________________

Semnatura sefului de serviciu _________

 

FIŞĂ MEDICALĂ SINTETICĂ

Dosar nr.  …………………………………………

Data înregistrării……………………………………………..

Numele medicului………………………………………………………………

 

FIŞĂ MEDICALĂ SINTETICĂ

 

Nume…………………………………….……..…….Prenume………………………………………………….….…………………….Vârsta………

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II. Diagnosticul medical ( se specifică şi nr. cod ICD 10):

- principal…………………………………………………………………………………………………………………………………………………………

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-altele………………………………………………………………………………………………………………………………………………………………

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     Certificatele medicale actuale ( se specifică nr., data, instituţia emitentă şi numele medicului care a eliberat certificatul)………………………………………………………………………………………………………………………………………………………

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III. Tratamente urmate şi recomandate

Nr

Crt.

   Tipul tratamentelor     

                  Tratamente urmate ( scurtă descriere)

Tratamente recomandate  (se bifează)

  1.

Medicamentoase

 

   

  2.

Recuperare

neuromotorie

   

  3.

Chirurgicale

   

  4.

Protezare

   

  5.

Ortopedice

   

  6.

Psihoterapie

   

  7.

Recuperare

Psihică

   

  8.

Oftalmologie

   

   9.

Audiologie

 

   

 10.

ORL

 

   

 11.

Cardiologie

 

   

 12.

Fizioterapie

 

   

 13.

Endocrinologie

 

   

 14.

Gastroenterologie

 

   

 15.

Neurologie

 

   

 16.

Altele ( cu

specificaţie)

   

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În cazul absenţei  oricărui tratament, enumeraţi motivele pe care le invocă familia: …………………………………………………………………………………………………………………………………………………………………………

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V. Stadiul actual al bolii ( înconjuraţi etapa care se potriveşte:

                   - de debut;                                  - de stare evolutiv /stabilizat;                           - terminal.

 

 

Data completării fişei …………………………………………………

Semnătura medicului ………………………………………………..