FICHA+DE+ANAMNESE01
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FICHA DE ANAMNESE
FICHA DE ANAMNESE1) Dados gerais do paciente:
Nome:__________________________________________________________________________ Idade:______ Sexo______ Data de Nasc:___/___/___ Profisso:___________________________
Estado Civil:___________________ Filhos: ( )________________________________________
End: ___________________________________________________________________________
Tel:______________________________ e-mail:_______________________________________
QP:_________________________________ HD:_______________________________________
HMA:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2) Avaliao do paciente:
Sinais Vitais: PA:_________ FC:________ T:_______ Peso:_______ Alt:______ IMC:_______
Diabetes( ) Hipertenso Arterial ( ) Tabagismo ( ) Alcoolismo ( )
Cirurgias( ) _____________________________________________________________________
Exerccios Fsicos( ) ___________________________ Freqncia: ________________________
Problemas respiratrios( ) ________________________ Alergia( )________________________
3) Distrbios:
Digesto( ) Cibras( ) Convulses( ) Fibromialgia( ) Ansiedade( ) Depresso( )
Outros:__________________________________________________________________________
4) Avaliao Postural
Cifose( ) Lordose( ) Escoliose( ) Joelho: Valgo( ) Varo( ) P:Cavo( ) Plano( ) Normal( )
Observaes: _____________________________________________________________________
________________________________________________________________________________
5) Observaes Gerais:____________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________
6) Objetivo Principal: _____________________________________________________________
________________________________________________________________________________
7) Conduta: _____________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Nome: _________________________________________________ RG: _____________________ Ciente:__________________________________________________________________________
Massoterapeuta: __________________________________________________________________
Catanduva SP Data:___/___/___
TRATAMENTO1 sesso(___/___/___) Conduta:____________________________________________________
________________________________________________________________________________
Evoluo:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2 sesso(___/___/___) Conduta:____________________________________________________
________________________________________________________________________________
Evoluo:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3 sesso(___/___/___) Conduta:____________________________________________________
________________________________________________________________________________
Evoluo:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4 sesso(___/___/___) Conduta:____________________________________________________
________________________________________________________________________________
Evoluo:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Observaes Adicionais: __________________________________________________________
________________________________________________________________________________________________________________________________________________________________
Massoterapeuta:____________________________________________________
Auxiliar:___________________________________________________________