Ficha Personal Estudiante Nombres Apellidos Fecha de Nac. Rut Dirección Correo Electrónico N° de Hermanos(as) Curso Profesor(a) Jefe N.E.E Diagnostico Medicamento Tratamiento Ingreso P.I.E Autorización Imagen DATOS FAMILIARES : ………………................................................................. : ………………................................................................. : Día:....................Mes:..............................Año................ : ………………................................................................. : ………………................................................................. : ................................Lugar que ocupa:....................... : …………….................................................................... :………………................................................................. : …………….................................................................... : ……………………………………………………………... : ..................................................................................... : ..................................................................................... : ..……………………………………….................................... : ..………………………………………...................................... : Si No MADRE/ PADRE/TUTOR Nombre Completo Parentesco Correo Teléfono/ Celular MOTIVO DESCOMPENSACIÓN O DISGUSTO GUSTOS Y/O PREFERENCIAS 1. 2. 3. 1. 2. 3. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 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