CONSULTA PEDIATRICA DATA:_____________

NOME:__________________________________________________________IDADE:_________________________
NOME MÃE:____________________________________________SEXO BEBE:_______________________________
DADOS GESTAÇÃO E NASCIMENTO:__________________________________________________________________
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TESTES DE TRIAGEM NEONATAL: ____________________________________________________________________
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VACINAS:_______________________________________________________________________________________
DADOS DE ALIMENTAÇÃO:_________________________________________________________________________
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HABITOS INTESTINAIS E VICERAIS:___________________________________________________________________
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SONO:__________________________________________________________________________________________
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HIGIENE:________________________________________________________________________________________
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ROTINA/ AMBIENTE/ ROTINA FAMILIAR:______________________________________________________________
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COMORBIDADES FAMILIARES/ IRMÃOS:_______________________________________________________________
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ALERGIAS/ MEDICAÇÕES EM USO:___________________________________________________________________
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ANTECEDENTES:__________________________________________________________________________________
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COMPORTAMENTO/DESENVOLVIMENTO:_____________________________________________________________
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QUEIXAS E DUVIDAS:______________________________________________________________________________
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EXAME FISICO:___________________________________________PESO:_______PC:_____COMPRIMENTO:_______
CABEÇA/PESCOCO/OROSC:___________________________________________________GANHOS:______________
A.CARDIACA:____________________________________________________________________________________
A.RESPIRATORIA:_________________________________________________________________________________
ABD:___________________________________________________________________________________________
EXTREMIDADES E MEMBROS:_______________________________________________________________________
GENITAL:_______________________________________________________________________________________
SN:____________________________________________________________________________________________
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ORIENTAÇÕES:___________________________________________________________________________________
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HD:____________________________________________________________________________________________
CONCLUSÃO:____________________________________________________________________________________
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