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Motivo da consulta: _______________________________________

Queixa principal

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História da doença atual

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HPP

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Exame Psíquico

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Histórico de doenças

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Aparência Fala e Linguagem

⃝ Abatido ⃝ Hipofônica

⃝ Roupas adequadas ⃝ Hiperfônica

⃝ Roupas descuidadas ⃝ Hipoprosódica

⃝ Roupas chamativas ⃝ Hiperprosódica

⃝ Roupas provocantes ⃝ Bradifasia (Bradilalia)

⃝ Apática ⃝ Taquifasia (Taquilalia)

⃝ Indiferente ⃝ Logorreia
(Verborreia/Verborragia)
⃝ Dentes sujos
⃝ Mutismo
⃝ Higiene descuidada

⃝ Cabelos limpos
Consciência
⃝ Cabelos sujos
⃝ Alerta/Vigil
⃝ Cabelos desarrumados
⃝ Sonolento
⃝ Outros
_____________________ ⃝ Obinubilado
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⃝ Turvação/Torporoso
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_____________________ ⃝ Coma
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_____________________ ⃝ Estreitamento de
campo e consciência
Atenção

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Pensamento

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Inteligência

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Conduta terapêutica

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Sensopercepção

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Afeto

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Psicomotricidade

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Conação

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Humor

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Memória

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Pragmatismo

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Consciência

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Consciência de morbidade

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Diagnóstico sindrômico

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Diagnóstico Nosológico

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