Roteiro de anamnese (adulto / idoso)

Nome:________________________________________ Idade: ____________

DN: ______________________ Escolaridade: _________________________
Médico solicitante: _____________________________

Queixa principal:
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História da doença:
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Queixas cognitivas:
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Personalidade prévia: (como é seu jeito de ser? Continua assim ou ocorreu alguma
mudança?)
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Alterações comportamentais: (mudou de comportamento após ser acometido pela

doença?)
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Escolaridade/Profissão: (qual o nível de escolaridade e em que trabalha, como foi a
trajetória profissional)
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Vida social: (convive com quem, atividades fora de casa, participa de algum tipo de
grupo (igreja, clube, etc.))
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Dinâmica familiar (com quem mora, irmãos (idades e profissões), pais (idades e
profissão), arranjo familiar, familiar de referência):
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Hábitos e rotina (o que gosta de fazer, preferências, alimentação, sono):

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Antecedentes familiares (algum familiar tem alguma doença relacionada com a do

paciente?):
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Medicação:
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Outras condições médicas: (perguntar se tem colesterol alto, pressão ou algum outro
tipo de doença)
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Exames:
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Tratamentos:
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