Avaliação Neurológica

DATA da AVALIAÇÃO:
Anamnese
Paciente: ___________________________________________________________________ Idade: _________ Sexo: ____
RG:___________________________
CPF: _______.______.______-_____ data de Nascimento: __ / __ / ____
End:__________________________________________________________ Tel: (_____) ______ - ____ - ____
Estado civil: _____________ Profissão: _____________________________ FC: ______ FR: _____ PA: ______

HMA:

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QP/duração:

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HD: ________________________________________________________________________________________________

Antecedentes pessoais e Familiares

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Exames complementares

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Medicamentos:

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 Rotina pré-morbidade:

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Rotina pós-morbidade (sono / alimentação / funções vesical e intestinal / atividade física / etc):

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Possui cuidador?
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AVDs:

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 Cognição:

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EXAME FÍSICO
 Inspeção:
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Exame Sensorial
o Sensibilidade Superficial:
 Tato:

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 Dor:
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 Temperatura:
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o Sensibilidade Profunda:
 Pressão:
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 Propriocepção (cinestesia / artrestesia):

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Exame Perceptual:
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Obs.:
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Exame motor:

o Motricidade Voluntária:
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o ADM:
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o Tônus:
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o Reflexos:
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o Coordenação motora:
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o Equilibrio:
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o Força:
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o Mudanças de decúbito:
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o Transferências:
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o Marcha:
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Obs.:
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Avaliador: ______________________________________________ Data:____ / ____ / ____