INFORME DE EXAMEN MENTAL

I. DATOS GENERALES
. Nombres y apellidos :..
. Edad :..
. Sexo : F M
. Fecha de nacimiento :..
. Lugar de nacimiento :..
. Nmero de hermanos :..
. Lugar entre hermanos :..
. Domicilio :..
. Telfono :..
. Grado de instruccin :..
. Estado civil :..
. Fecha de evaluacin :..
. Entrevistador :..

II. DESCRIPCIN GENERAL

a) Apariencia
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b) Comportamiento y actividad motora
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c) Actitud hacia el examinador
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III. HUMOR Y AFECTO
a) Humor
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 b) Afecto
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c) Propiedad
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IV. LENGUAJE
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V. ALTERACIONES SENSOPERCEPTIVAS
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VI. PENSAMIENTO
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VII. SENSORIO Y COGNICIN

a) Alerta y nivel de conciencia
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b) Orientacin
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c) Memoria
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d) Concentracin y atencin
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e) Capacidad de lectura y escritura
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f) Habilidad viso espacial
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g) Pensamiento abstracto
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h) Consolidacin de informacin de inteligencia
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VIII. CONTROL DE IMPULSOS
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IX. JUICIO E INSIGHT
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X. FIABILIDAD
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Anexos.
Examen mental del evaluado.