FICHA DE AVALIAÇÃO - “ANAMNESE”

 DIAGNÓSTICO MÉDICO (SE TIVER):

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 QUEIXA PRINCIPAL:
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 HMP/ HMA:
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 CIRURGIA:
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 FRATURA E LESÕES TRAUMÁTICAS:

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  MEDICAMENTOS:

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 EXAMES COMPLEMENTARES:
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 SINAIS CLÍNICOS:
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PONTOS AURICULARES:
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 MELHORA: __________ % ANTES / __________ % DEPOIS

 ORIENTAÇÃO DOMICILIAR:
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 OBS:
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SESSÃO 1 - DATA: _____/_____/_____

 EVOLUÇÃO: MELHORA: __________ % ANTES / __________ % DEPOIS

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PONTOS AURICULARES:
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SESSÃO 2 - DATA: _____/_____/_____

 EVOLUÇÃO: MELHORA: __________ % ANTES / __________ % DEPOIS

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PONTOS AURICULARES:
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 SESSÃO 3 - DATA: _____/_____/_____

 EVOLUÇÃO: MELHORA: __________ % ANTES / __________ % DEPOIS

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PONTOS AURICULARES:
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SESSÃO 4 - DATA: _____/_____/_____

 EVOLUÇÃO: MELHORA: __________ % ANTES / __________ % DEPOIS

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PONTOS AURICULARES:
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