Anamnese Completa do Adulto

Nome:____________________________________________________________________
Data de nascimento: ____________________ Idade:_________ Sexo:_________
CPF: ___________________________
Endereço:_________________________________________________________________
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Telefones para Contato:______________________________________________________
Bairro:____________________________ Cidade:________________________________
Escolaridade/ formação: _____________________________________________________
Filhos (nome, idade e sexo) __________________________________________________
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Profissão:_________________________________________________________________
Est.Civil:___________________
Cônjuge (nome, idade e profissão):_____________________________________________

Queixa principal:___________________________________________________________
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Quem fez o encaminhamento? ________________________________________________

Hipótese diagnóstica: _______________________________________________________
Fez avaliação anteriormente? Quando? _________ ________________________________
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Expectativas e objetivos do paciente:___________________________________________
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Sintomas apresentados:______________________________________________________
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Transtornos psiquiátricos anteriores:____________________________________________

Transtornos psiquiátricos familiares:____________________________________________

Doenças Importantes que teve:________________________________________________

Medicação que está tomando _________________________________________________

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Medicação alternativa (chás, compostos, etc.)_____________________________________
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Realizou algum exame? Se sim, qual resultado: ___________________________________
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1
Histórico da Queixa
Quando se iniciou:__________________________________________________________
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Eventos/fatores que precipitam ou agravam crises:_________________________________
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Eventos traumáticos de vida:__________________________________________________

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Uso de drogas? ____________________________________________________________

Tentativa de suicídio? _______________________________________________________

Dinâmica familiar atual: _____________________________________________________

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Infância (onde nasceu, tipo de parto, foi criado por quem, como eram os pais, tem irmãos)
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Adolescência ( como foi a educação, ficou reprovado, era cuidadoso com materiais)
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Vida Adulta (trabalha, estuda, mais de um casamento, gastos, laser, sexo)

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O que as pessoas dizem sobre você: ____________________________________________
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Situação Financeira:_________________________________________________________
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Meios que frequenta atualmente (lazeres, vida social): _____________________________

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Outros transtornos atuais (sono, alimentação, tiques, etc.):
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Comportamento e Linguagem Não verbal do Paciente:

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Faz outros acompanhamentos:

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Outras Observações Importantes:______________________________________________

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São Luís – MA, ________ de _________________ de 2020.

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