Curso de Fisioterapia

Estágio Supervisionado em Ortopedia, Traumatologia e Reumatologia I

FICHA DE AVALIAÇÃO

IDENTIFICAÇÃO
Data da Avaliação: ___/____/____
Nome:__________________________________________________________________________________________
Data de nascimento: ___/___/___ Idade:__________ Sexo: F ( ) M ( ) Fone:____________________________
Endereço:_______________________________________________________________________________________
Ocupação:_________________________________________________________Estado Civil:___________________
Diagnóstico Médico:_________________________________________Médico:_______________________________
Estagiário:______________________________________________________________________________________

ANAMNESE

Queixa Principal:_________________________________________________________________________________
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H.D.A:__________________________________________________________________________________________
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H.D.P:__________________________________________________________________________________________
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Medicamentos:__________________________________________________________________________________
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Exames Complementares:_________________________________________________________________________
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EXAME FÍSICO:

Sinais Vitais: FC__________ FR__________ PA__________ Tº__________ SpO2__________

Inspeção e Palpação:______________________________________________________________________________
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Amplitude de Movimento (ativo e passivo/ ADM limitada com ou sem dor):
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Perimetria/medidas de comprimento:_______________________________________________________________
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Teste de Força Muscular (avaliar também presença/ausência de dor):
5 - Normal 4 - Bom 3- Regular 2 - Ruim 1 - Traço Zero
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Reflexos de Estiramento e Sensibilidade cutânea:
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Testes Especiais:
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Avaliação Postural:
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Outras observações importantes:

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Diagnóstico Fisioterapêutico Objetivos Condutas terapêuticas

Evolução:
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