anamnese 259 palavras 2 páginas Exibir mais SETOR DE FISIOTERAPIA FICHA DE AVALIAÇÃO- Anamnese Nome:______________________________________________Sexo:_________ Profissão:_________________________ Hor.de trab:____________________ DN:____/____/____ Idade:______________ Raça:____________________ Naturalidade:________________ Tel:__________________________________ Endereço: _________________________________________________________________ _________________________________________________________________ Dados para o convênio:_____________________________________________ Encaminhamento:__________________________________________________ Diagnóstico Clínico:________ _______________________________________ Diagnóstico Fisioterapêutico: _______________________________________ Q.P:__ __________________________________________________________ _________________________________________________________________ HPA:____________________________________________________________ __________________________________________________________________________________________________________________________________ Patologias associadas: ______________________________________________ HPP: ____________________________________________________________ __________________________________________________________________________________________________________________________________ HSF: ____________________________________________________________ _________________________________________________________________ Medicação atual: _________________________________________________ _________________________________________________________________ Terapia anterior: __________________________________________________ _________________________________________________________________ Exames Complementares:__________________________________________