FI

CHA DE AVALI
AÇÃO - VENTOSATERAPI
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NOM E:
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DADE:
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ENDEREÇO:
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TELEFONE:
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SSÃO:
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DI
AGNÓSTI
CO:
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M ÉDI
CO RESPONSÁVEL:
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DI
AGNÓSTI
CO M ÉDI
CO:
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ESPECI
ALI
DADE DO M ÉDI
CO:
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DATA DA ADM I
SSÃO:
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QUEI
XA PRI
NCI
PAL:
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ESCALA VI
SUAL DA DOR

HI
STÓRI
A DA DOENÇA ATUAL:
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COM O SÃO OS SEUS HÁBI
TOS ALI
M ENTARES?
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HI
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A PREGRESSA:
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