You are on page 1of 3

sssINFORME FONOAUDIOLÓGICO

I. DATOS DE IDENTIFICACIÓN

Nombre : ____________________________________________________
Fecha de Nacimiento : ____________________________________________________
Edad : ____________________________________________________
Escolaridad : ____________________________________________________
Fecha de Evaluación : ____________________________________________________
Examinador : ____________________________________________________

II. MOTIVO DE CONSULTA


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

III. ANTECEDENTES DE EVALUACIÓN

1. Órganos Fonoarticulatorios:

Labios : __________________________________________________________
Lengua : __________________________________________________________
Paladar duro : __________________________________________________________
Paladar blando: _________________________________________________________
Dientes : __________________________________________________________
Mordida : __________________________________________________________
Amígdalas : __________________________________________________________

2. Praxias Bucolingüofaciales:

Praxias Linguales : ____________________________________________________


Praxias Labiales : ____________________________________________________
Praxias en secuencia : ____________________________________________________

3. Voz y audición:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
 HABLA

Articulación: __________________________________________________________
______________________________________________________________________
______________________________________________________________________

Fluidez, ritmo y prosodia: _______________________________________________


______________________________________________________________________
______________________________________________________________________

 LENGUAJE EXPRESIVO

Nivel Fonológico: _______________________________________________________


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Nivel Semántico: _______________________________________________________


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Nivel Morfosintáctico: __________________________________________________


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

 LENGUAJE COMPRENSIVO

Nivel Fonológico: _______________________________________________________


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Nivel Semántico: _______________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Nivel Morfosintáctico: __________________________________________________


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Nivel Pragmático: ______________________________________________________


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

IV. DIAGNÓSTICO:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

V. INDICACIONES Y/O SUGERENCIAS:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

VI. OBSERVACIONES:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

You might also like