Coordenadoria Municipal da Sade de guas de Santa Brbara

ESTRATGIA SADE DA FAMLIA PARQUE DOS LAGOS

PROGRAMA DE HIPERTENSO E DIABETE

IDENTIFICAO
Nome:______________________________________ DN___/___/___Pronturio:______
Endereo:_________________________________________ACS:_________________________

HD: Hipertenso ( ) Diabete ( )

PATOLOGIAS ASSSOCIADAS
Doenas cardio vascular ( ) Hepatopatias ( ) Alcoolismo ( ) Tabagismo ( )
Dislipidemia ( ) Cncer ( ) Varizes ( ) Outros:_______________________________________

EXAMES LABORATORIAIS
Data___/___/___ Creatinina_______________Sdio______________Potssio_______________
Urina_____________Colesterol_____________Triglicrides______________Uria___________
Glicemia______________E.C.G________________Outros:______________________________
REGISTRO DE CONTROLE DE PA

data

temp.

peso

PA

edema

fc

ritmo

glicemia

retorno

Intercorrncia/Conduta:___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________Assinatura:_________________________

data

temp.

peso

PA

edema

fc

ritmo

glicemia

retorno

Intercorrncia/Conduta:___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________Assinatura:_________________________

data

temp.

peso

PA

edema

fc

ritmo

glicemia

retorno

Intercorrncia/Conduta:___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________Assinatura:_________________________

data

temp.

peso

PA

edema

fc

ritmo

glicemia

retorno

Intercorrncia/Conduta:___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________Assinatura:_________________________

data

temp.

peso

PA

edema

fc

ritmo

glicemia

retorno

Intercorrncia/Conduta:___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________Assinatura:_________________________

data

temp.

peso

PA

edema

fc

ritmo

glicemia

retorno

Intercorrncia/Conduta:___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________Assinatura:_________________________