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:___________________________________________________________
