AVALIAÇÃO GLOBAL DA VOZBEHLAU E PONTES, 1989

ANAMNESE

1- IDENTIFICAÇÃO PESSOAL

Nome______________________________________________________________________________Idade_____________________ Nascimento ____ / ____ /____ Local__________________________Nacionalidade______________________________ Estado civil______________________________Profissão___________________________________________________________________________Período de trabalho___________________________________________________________________Outra atividade______________________________________________________________________Endereço____________________________________________Telefones_______________________Encaminhado por____________________________________________________________________Médico____________________________________________________________________________

2- QUEIXA E DURAÇÃO_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3- HISTÓRIA PREGRESSA DA DISFONIA___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4- INVESTIGAÇÃO COMPLEMENTARa)Distúrbios alérgicos, faringicos, bucais, nasais, ontológicos, pulmonares, digestivos, hormonais e neuro-vegetativos.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b)Antecedentes pessoais_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c)Antecedentes familiares______________________________________________________________________________________________________________________________________________________________________

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d)Impressão sobre a própria voz_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

e)Impressão de outros sobre sua voz_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5- TRATAMENTO JÁ EFETUADO PARA A DISFONIAMedicamentoso, fonoterapico, cirúrgico, psicoterápico, outros__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6- OUTROS DADOS E OBSERVAÇÕES_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Motivação para a terapia e para seguir a conduta em casa______________________________________________________________________________________________________________________________________________________________________

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