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ESCOLA ESTADUAL PROFESSORA DIOGUINA AUGUSTA SANTANA

SERVIO DE SUPERVISO
DATA:_________/________ DE 201__
PROFESSOR (A):___________________________________________________________________
TURMA_______ ANO____
FOCO DE OBSERVAO DA COORDENADORA:
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1- rea do Conhecimento / Contedo trabalhado pelo Professor (a) durante a visita:
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2- Atividades Propostas pelo Professor (a):
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3-Estratgias Didticas utilizadas pelo Professor (a):
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4-Material utilizado pelo Professor (a):
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5- Interesse e Participao dos Alunos:
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DEVOLUTIVA DA COORDENADORA PARA O PROFESSOR (A)


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(cidade),___________________________________________________ ____/____/________.

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Supervisora
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Professor(a)
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Diretora

FICHA DE INFORMAES MDICAS DOS ALUNOS

A - Identificao do (a) aluno (a)

Escola (preencher a lpis):


Unidade Bsica de Sade mais prxima (a lpis):
Nome:
Matrcula do posto:
Data de Nascimento: __ / __ / __

Sexo: ( ) M

( )F

Nome do Pai:

Telefone (a lpis):

Nome da Me:

Telefone (a lpis):

Responsvel:

Telefone (a lpis):

Endereo (a lpis):

B - Dados do calendrio vacinal

Atualizado ( )

Atrasado ( )

Sem informao ( )

C - Dados sobre o (a) aluno (a)

1. O aluno (a) vive com:

2. O parto foi:

pais ( ) s pai ( ) s me ( ) outros ( )


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normal ( ) cesrea ( ) frceps ( ) prematuro ( )

catapora ( ) meningite ( ) hepatite ( ) dengue ( ) pneumonia ( )


3. Doenas que j teve:

ALERGIAS: na pele ( ) alimentar ( ) bronquite ( ) rinite ( ) outra


( ) __________

4. Teve problemas no crescimento?

SIM ( ) NO ( ) Qual? ___________________

5. Teve atraso no desenvolvimento?

6. Tem alguma dificuldade de:

7. Tem ou teve problema no corao?

SIM ( ) NO ( ) Qual? ___________________


enxergar ( ) falar ( ) ouvir ( ) andar ( ) movimentar braos e pernas
( )
SIM ( ) NO ( ) Qual? ___________________

8. Faz acompanhamento desse problema? SIM ( ) NO ( ) Onde? __________________


9. Tem alergia a algum medicamento?

SIM ( ) NO ( ) Qual? ___________________

10. Tem intolerncia a lactose?

SIM ( ) NO ( )

11. Tem intolerncia ao glten?

SIM ( ) NO ( )

12. Tem alguma deficincia?

SIM ( ) NO ( ) Qual? ___________________

13. Usa alguma prtese?

SIM ( ) NO ( ) Qual? ___________________

14. Tem ou teve desmaio ou convulso?

SIM ( ) NO ( )

15. Toma alguma medicao?

SIM ( ) NO ( ) Qual?_ ______________ Para qu?


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16. acompanhado por causa disso?

SIM ( ) NO ( ) Onde? ___________________

17. Tem diabetes?

SIM ( ) NO ( )

18. Faz tratamento por causa disso?

SIM ( ) NO ( )

19. Tem algum problema na coluna?

SIM ( ) NO ( ) Qual? ___________________

20. J teve alguma fratura?

SIM ( ) NO ( ) Qual? ___________________

21. Tem dificuldades para caminhar?

SIM ( ) NO ( )

22. J se submeteu a alguma cirurgia?

SIM ( ) NO ( ) Qual? ___________________

23. Tem problema com peso?

SIM ( ) NO ( )

24. J esteve internado?

SIM ( ) NO ( ) Por qul? ________________

25. Faz algum tratamento especializado?

psiclogo ( ) fonoaudilogo ( ) terapia ocupacional ( ) outro ( ) Qual?


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D - Outras observaes

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Nova Belm,_____de _________ de ________


Assinatura do Pai ou responsvel: _________________________________
Data: __ / __ / __

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