Ficha clnica

Antecedentes personales

o Nombre:
o Edad:
o Fecha de nacimiento:
o Nacionalidad:
o Rut:
o Telfono:
o Ocupacin u oficio:
o Estado civil:
o Hijos:
o Direccin:
o Lateralidad o dominancia:
o Fecha de ingreso:
o Diagnstico mdico:

Anamnesis remota

o Antecedentes mrbidos :
-HTA:
-DM:
-Problemas reumticos:
-Artritis:
-Artrosis:
-Otra enfermedad crnica:
o Medicamentos:

o Antecedentes familiares:

o Hbitos:
-Consumo de alcohol:
-Fumador (a):
-Deporte o actividad fsica:
-Otro:
o Alrgias:
o Antecedentes mdicos (cirugas/hospitalizaciones):

o Antecedentes de vivienda (opcional):

Anamnesis Prxima

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

Exmenes complementarios:

Evaluacin

o General:
-observacin inicial:
___________________________________________________________________
___________________________________________________________________
-Postura:
___________________________________________________________________
___________________________________________________________________
-equilibrio:
___________________________________________________________________
___________________________________________________________________
-Marcha:
___________________________________________________________________
___________________________________________________________________

o Especifica o segmentaria:
-Inspeccin:
___________________________________________________________________
___________________________________________________________________
-Palpacin:
___________________________________________________________________
___________________________________________________________________
-Dolor:
___________________________________________________________________
___________________________________________________________________
-ROM:
___________________________________________________________________
___________________________________________________________________
-End feel:
___________________________________________________________________
-Fuerza muscular:
___________________________________________________________________
 -Sensibilidad (profunda y superficial):
___________________________________________________________________
___________________________________________________________________

CIF

Deterioros Alteraciones Limitacin en Restriccin Componentes

estructurales (por funcionales actividades en la ambientales y
sistema) participacin personales

Diagnostico kinsico:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

Objetivos:

General:____________________________________________________________
___________________________________________________________________
Especfico:__________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
 Operacionales:_______________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Pronstico:

Plan kinsico:

Reevaluacin: