FICHA DE AVALIAÇÃO FISIOTERAPÊUTICA EM TRAUMATO – ORTOPEDIA

NOME:________________________________________________SEXO: ________________________
IDADE:_______ DATA DE NASCIMENTO: ____/_____/_____ ESTADO CIVIL: ______________________
ENDEREÇO:__________________________________________________________________________
ESCOLARIDADE: ________________________________PROFISSÃO: ____________________________
TELEFONE: ____________________________

DIAGNÓSTICO CLÍNICO:
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QUEIXA PRINCIPAL:
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H.D.A:
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ANTECEDENTES PESSOAIS:
Etilista ( ) Tabagista ( ) Hipertenso ( ) Diabetes ( ) Labirintite ( ) Oncológico( )
Cardiopatia ( ) Outros:________________________________________________________________

ANTECEDENTES FAMILIARES:
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MEDICAÇÕES EM USO:
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CIRURGIAS:
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SINAIS VITAIS:
FC: ________________________ FR: ________________________ PA:________________________
DOR: Não ( ) Sim ( ) Local (ais):______________________________________________________

INSPEÇÃO/MARCHA/ADM:
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PALPAÇÃO:
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AVALIAÇÃO POSTURAL:
REGIÃO SAGITAL FRONTAL
Pé

Joelho

Cintura pélvica

Coluna

Cintura escapular

Cabeça

FORÇA MUSCULAR:
GRUPO DIREITO ESQUERDO
MUSCULAR
GONIOMETRIA:
ESTRUTURA DIREITO ESQUERDO

PERIMETRIA:
PONTO ANTÔMICO 1° 2° 3° MÉDIA

TESTES ESPECIFÍCOS:
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EXAMES COMPLEMENTARES:
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DIAGNÓSTICO FISIOTERAPÊUTICO:
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OBJETIVOS:
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CONDUTAS:
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AVALIAÇÃO:____/_____/________ ALUNOS:______________________________________________
PRECEPTOR:_________________________________________________________________________