Atesto, para os devidos fns, que o(a)candidato(a)___________________________________________________________________________________________________________portador do documento de identifcao n _____________________________________, examinado por mim nesta data, apresenta as seguintes condies psquicas:-conscincia:________________________________________________________________________________________________________________________________________!-orientao:_________________________________________________________________________________________________________________________________________!-ateno:________ ___________________________________________________________________________________________________________________________________!- pensamento (curso, "orma e conte#do):_________________________________________________________________________________________________________________!-mem$ria:__________________________________________________________________________________________________________________________________________!-senso percepo:_________________________________________________________!_________________________________________________________________________!-%umor&a"eto:_______________________________________________________________________________________________________________________________________!-cognio&inte'igncia________________________________________________________________________________________________________________________________!-capacidade de tirocnio e (u)o crtico:__________________________________________ _________________________________________________________________________!-'inguagem:________________________________________________________________ _________________________________________________________________________!-uso ou no de medicamentos psicotr$picos (psico"*rmacos):________________________ _________________________________________________________________________+,onc'uso:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________+(-orta'e)a&,e), ______ de_________________ de ./0_+Atenciosamente,_____________________________________________________________