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PREFEITURA MUNICIPAL DE JARDIM

CENTRO DE ACOLHIMENTO AO COVID-19

FICHA DE ATENDIMENTO

NOME:___________________________________________________________________________________
SUS/CPF:____________________________________________DN:_____/_____/_____
ENDEREÇO: ________________________________________________________________________________
EXAME: RT-PCR (+) (-) TR ANTÍGENO(+) (-) TR ANTICORPO (+) (-) DATA DO RESULTADO____/_____/______
Quais sintomas apresentados: Inicio dos Sintomas______/_____/_____
( ) febre ( ) coriza ( ) náusea/vômitos
( ) tosse ( ) Dispneia/taquipneia ( ) dor de cabeça
( )perda de olfato ( ) Perda Paladar ( ) diarreia
( ) Dor de Garganta Outros sintomas:____________________________________
Mórbidades prévias:_________________________________________________
( ) hipertensão ( ) diabetes ( ) doença hepática ( ) obesidade
( ) doença neurológica crônica ou neuromuscular ( ) imunodeficiência
( ) Infecção pelo HIV ( ) doença renal ( ) Doenças Respiratórias_______________
DATA DO ATENDIMENTO: ______/______/______
PA:__________PESO:_________ALTURA:___________TAX:_________SATO2_____________________________
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DATA DO ATENDIMENTO: ______/______/______


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DATA DO ATENDIMENTO: ______/______/______


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DATA DO ATENDIMENTO: ______/______/______


PA:__________PESO:_________ALTURA:___________TAX:_________SATO2_____________________________
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