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Ana Voz 1
Ana Voz 1
Data: _________________________________________
Nome: __________________________________________________________________
Data de Nasc: ________________________________
End: ____________________________________________________________________
Telefone: _____________________________________
Profisso:__________________________________________________
Motivo da Consulta:
Antecedentes:
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" Afeces vocais anteriores:
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" Audio:
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" Taquicardia/bradicardia?
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Distrbios Hormonais:
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" Obesidade?
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" Emagrecimento?
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Mulher:
" Abortos?
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" Partos?
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" Contraceptivos?
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Distrbios Emocionais:
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Alergias:
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" Alrgico?
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" Incio:
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" Grita?
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" Ar-condicionado?
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" Fuma?
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Tratamentos anteriores:
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Fonte: http://www.profala.com/frameset.htm