PROVVEDITORATO   AGLI    STUDI   DI   CASERTA
Ufficio Studi e Programmazione

Prot.n.20232										       		      01/03/2001

										Ai Dirigenti scolastici degli Istituti di
ogni ordine e grado della provincia

													LORO SEDI

OGGETTO: Legge 104/92 – Integrazione scolastica degli alunni in situazione di handicap. 
        Trasmissione allegati al protocollo d’intesa Provveditorato agli Studi di Caserta - ASL CE/1 – ASL CE/2.

In riferimento alla nota pari protocollo dell’8/1/2001, si trasmette alle SS.LL. copia degli allegati al protocollo d’intesa  siglato dal Provveditorato agli Studi di Caserta, dalla ASL CE/1 e dalla ASL CE/2, finalizzato alla promozione di interventi per l’integrazione scolastica degli alunni in situazione di handicap  nelle scuole di ogni ordine e grado della provincia.

								PER	IL PROVVEDITORE AGLI STUDI
										Ercole Ammaturo
									F.to Dott. Luigi De Filippis

AZIENDA     SANITARIA     LOCALE    CE _____ 

DISTRETTO  N._______ 

INDIVIDUAZIONE DELL’ALUNNO COME PERSONA HANDICAPPATA AI FINI DEGLI ADEMPIMENTI DI CUI AGLI ARTT. 12 E 13 DELLA LEGGE N.104/92( D.P.R. .24/02/94)

Anno Scolastico  ___________

Alunno/a ____________________________________________________________________ 

nato/a _________________________________________________il ____________________ 

residente a ___________________________________________________________________ 

in via ______________________________________n._______tel. ______________________ 

iscrizione prevista/iscritto alla Scuola/Circolo/Istituto _________________________________ 

_________________________________________classe______________sez _____________ 

DIAGNOSI : _________________________________________________________________ 

____________________________________________________________________________ 

____________________________________________________________________________ 

____________________________________________________________________________ 

________________________ 
      ( data )                                                                                    LO  SPECIALISTA

ASSENSO   DEGLI   ESERCENTI   LA   POTESTA’

PER L’INDIVIDUAZIONE DEL_____PROPRIO FIGLIO/A, AI SENSI DELLA L. 104/92 e D.P.R. 24/2/94, AI FINI DELL’ESERCIZIO DEL DIRITTO ALL’INTEGRAZIONE SCOLASTICA
( ART. 3, 1° COMMA L. 104/92 )

Il sottoscritto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
 
in qualità di (relazione di parentela) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
 
del minore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

nato a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . il . . . . . . . . . . . . . . 

residente a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Via . . . . . . . . . . . . . . . . . . . . . . . . . . 

frequentante la scuola. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . classe. . . . . . . . . . . .. 

ACCONSENTE

che venga attivata la procedura prevista dalla L. 104/92 e dal D.P.R. 24/2/94 relativa all’individuazione del/la proprio/a figlio/a come persona handicappata ai fini dell’esercizio del diritto all’integrazione scolastica.

DATA .................................							FIRMA

							          	...................................................

AL COORDINATORE
UNITA’ MULTIDISCIPLINARE
U.O.M.I.
DISTRETTO SANITARIO N°.......
VIA...............................................
CITTA’.........................................

OGGETTO: RICHIESTA INDIVIDUAZIONE ALUNNO PORTATORE DI HANDICAP

Si richiede di sottoporre

l’alunno..........................................................................................................................................

nato a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . il . . . . . . . . . . . . . .

residente a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .tel . . . . . . . . . . . . . . . . . . . . . . . . . . . 

frequentante la scuola. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  classe. . . . . . . . . . 

a visita per l’individuazione ai sensi della L. 104/92 e del D.P.R. 24/2/94.
Si allega alla presente l’assenso degli esercenti la potestà sull’alunno e relazione dei docenti curricolari.

									IL DIRIGENTE SCOLASTICO

REGIONE CAMPANIA
AZIENDA SANITARIA LOCALE CE/........

U.O.M.I. - DISTRETTO N° ...............
____________________________

UNITA’ MULTIDISCIPLINARE
(Art.3 D.P.R. 24.2.94)

DIAGNOSI FUNZIONALE
(Art. 12 - L. 104/92)

Alunno.............................................................................................................

REGIONE CAMPANIA
AZIENDA SANITARIA LOCALE CE/........
U.O.M.I. - DISTRETTO N° ...............
____________________________
UNITA’ MULTIDISCIPLINARE
(Art.3 D.P.R. 24.2.94)
DIAGNOSI FUNZIONALE
(Art. 12 - L. 104/92)

Prot. n°....................... del.......................
Rif. cart. clin. N°...................................			ANNO SCOLASTICO..........................

Alunno.............................................................................................................

nato a ............................................................................................il .............................................
residente a .............................................................................via....................................................
frequentante la classe....................................... sez.................. plesso..............................................
Scuola ....................................................................................... di ...............................................

DIAGNOSI ...................................................................................................................................

......................................................................................................................................................

DATI ANAMNESTICI SALIENTI.................................................................................................

......................................................................................................................................................

CONSEGUENZE FUNZIONALI...................................................................................................

......................................................................................................................................................

......................................................................................................................................................

INTERVENTI RIABILITATIVI IN ATTO ....................................................................................

......................................................................................................................................................

Necessita, pertanto di sostegno scolastico specializzato			 SI 		 NO
Necessita di aiuto personale perché non autonomo, per cui va segnalato al competente Ente Locale per gli adempimenti di cui all’articolo 9, comma 1, Legge 104/92					 SI 		 NO
Necessita di particolari presidi 							 SI 		 NO
quali ......................................................................................................
Incontra difficoltà a superare barriere architettoniche				 SI 		 NO

ESPRESSIONI SINTETICHE DI POTENZIALITA’ PRESENTI E DIFFICOLTA’ REGISTRABILI

A R E A      C O G N I T I V A

Potenzialità ....................................................................................................................................

......................................................................................................................................................

Difficoltà .......................................................................................................................................

......................................................................................................................................................

A R E A      N E U R O  - P S I C O L O G I C A

Potenzialità ....................................................................................................................................

......................................................................................................................................................

Difficoltà .......................................................................................................................................

......................................................................................................................................................

A R E A   A F F E T T I V O - R E L A Z I O N A L E
 
Potenzialità ....................................................................................................................................

......................................................................................................................................................

Difficoltà .......................................................................................................................................

......................................................................................................................................................

A R E A   L I N G U I S T I C A
 
Potenzialità ....................................................................................................................................

......................................................................................................................................................

Difficoltà .......................................................................................................................................

......................................................................................................................................................

A R E A     S E N S O R I A L E - N E U R O S E N S O R I A L E

Potenzialità ....................................................................................................................................

......................................................................................................................................................

Difficoltà .......................................................................................................................................

......................................................................................................................................................

A R E A      M O T O R I O - P R A S S I C A

Potenzialità ....................................................................................................................................

......................................................................................................................................................

Difficoltà .......................................................................................................................................

......................................................................................................................................................

A R E A   D E L L’ A U T O N O M I A 
 
Potenzialità ....................................................................................................................................

......................................................................................................................................................

Difficoltà .......................................................................................................................................

......................................................................................................................................................

A R E A   D E G L I  A P P R E N D I M E N T I 
 
Potenzialità ....................................................................................................................................

......................................................................................................................................................

Difficoltà .......................................................................................................................................

......................................................................................................................................................

OBIETTIVI DIDATTICO PEDAGOGICI DA PRIVILEGIARE NELL’ATTUALE MOMENTO VALUTATIVO

......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................…………………………………....

DIAGNOSI FUNZIONALE CONCLUSIVA

.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................…………………………………...

							
							L’UNITA’ MULTIDISCIPLINARE

AZIENDA SANITARIA LOCALE CE/........
DISTRETTO N° ............... U.O.M.I. 
 
UNITA’ MULTIDISCIPLINARE

SCUOLA/ ISTITUTO

________________________
( timbro della scuola )

PROFILO DINAMICO FUNZIONALE

DI

Cognome e nome_____________________________________________________

nato a ___________________________________________il_________________

residente a __________________________________ Via ____________________

scuola __________________________________ di_________________________

classe ________________ sez. ____________ plesso________________________

DIAGNOSI

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

DESCRIZIONE DELLE DIFFICOLTA’ PRESENTI E DELLE POTENZIALITA’

A R E A      C O G N I T I V A

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A R E A      A F F E T T I V O - R E L A Z I O N A L E 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A R E A      S E N S O R I A L E 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A R E A      N E U R O  - P S I C O M O T O R I A 

_________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A R E A   D E L L E  A U T O N O M I E 
 
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________

A R E A   L I N G U I S T I C A/ C O M U N I C A Z I O N A L E 
 ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________

A R E A   D E G L I   A P P R E N D I M E N T I  

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________

PROFILO DINAMICO FUNZIONALE
( redatto in forma conclusiva )

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SOSTEGNO SCOLASTICO: _______________________________________________________

Altro: _____________________________________________________________

Data: ___________________

I REDATTORI

SANITARI: ____________________________________
____________________________________
____________________________________
____________________________________
SCOLASTICI: ____________________________________
____________________________________
____________________________________
FAMILIARI: ____________________________________
____________________________________
____________________________________ 

AGGIORNAMENTO DEL PROFILO DINAMICO FUNZIONALE

Osservazioni:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SOSTEGNO SCOLASTICO: ___________________________________________
AIUTO MATERIALE: ________________________________________________
BARRIERE ARCHITETTONICHE: ______________________________________
ALTRO: ___________________________________________________________
DATA: _________________________

I REDATTORI

SANITARI: ____________________________________
____________________________________
____________________________________
____________________________________
SCOLASTICI: ____________________________________
____________________________________
____________________________________
FAMILIARI: ____________________________________
____________________________________
____________________________________ 

PIANO    EDUCATIVO
PERSONALIZZATO

Anno Scolastico ________/_____

Cognome_______________________________ Nome ____________________________

Nato/a il _________________ a ____________________________ Prov. _____________

Scuola ____________________________ Plesso ________________________________

classe _______ sez. __________

REDATTORI

Scuola _______________________
 _______________________
 _______________________
 _______________________

A.S.L. __________________________________

Famiglia ________________________________

Altri ___________________________________

									Data __________________

AREA PSICOMOTORIA

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AREA AFFETTIVO - RELAZIONALE

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AREA DELLE  AUTONOMIE

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AREA LINGUISTICA - COMUNICAZIONALE

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AREA SENSORIALE

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AREA DEGLI APPRENDIMENTI  Materia _________________   

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AREA DEGLI APPRENDIMENTI  Materia _________________   

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AREA DEGLI APPRENDIMENTI  Materia _________________   

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AREA DEGLI APPRENDIMENTI  Materia _________________   

Obiettivi
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contenuti
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Uso ed adattamento materiali
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Metodi di valutazione e verifica
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CONTENUTI GENERALI

Servizi occorrenti
__________________________________________________________________________________________________________________________________

Attenzioni particolari
___________________________________________________________________________________________________________________________________________________________________________________________________

Attività riabilitative
___________________________________________________________________________________________________________________________________________________________________________________________________

Organizzazione didattica  coordinamento
___________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________

Forme di integrazione fra scuola ed extrascuola
___________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________
VALUTAZIONE

FINE   ANNO   SCOLASTICO

Alunno/a ____________________________________________________

Scuola___________________________________

Considerazioni generali

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Necessita pertanto per l’anno scolastico ____________/ ______
di sostegno scolastico specializzato						 SI		 NO

necessita di aiuto personale perché non autonomo				 SI		 NO

necessita di particolari presidi							 SI		 NO

incontra difficoltà a superare le barriere architettoniche				 SI		 NO

Redattori

Scuola					A.S.L.				Famiglia

_____________			________________		_________________

_____________			________________		_________________