Ficha de Avaliação

Fisioterapia

Data da Avaliação: ____ /____ /_____

Ft. Responsável ________________________________________

Nome:________________________________________________________ Data Nascimento:___/___/_____ Idade_____

Profissão:_____________________________________________________ Lateralidade:_____________________________
Passatempos:__________________________________________________________________________________________
Agregado familiar: _____________________________________________________________________________________
Acesso Habitacional: ____________________________________________________________________________________

Exame Subjectivo
Diagnóstico Médico:​ ____________________________________________________________________________________
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Data e Tipo de Cirurgia: _________________________________________________________________________________
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Estado de Consciência:____________________ Estado Emocional:__________________ Orientação:__________________

História Clínica Actual:

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História Clínica Anterior:

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Questões Complementares

Medicação:____________________________________________________________________________________________
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HTA:________________________ Diabetes:____________________________ Patologia Cardiaca:_____________________
Exames Complementares de Diagnóstico: ___________________________________________________________________
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Sintomas

Descrição e Localização dos Sintomas:

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Intensidade: ( EVA ) _____________ Condição SIN da dor:___________________________________________________

Factores que agravam a dor:______________________________________________________________________________

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Factores que aliviam a dor: _______________________________________________________________________________

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Principais Problemas Referidos pelo Utente

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Actividades da Vida Diária

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Rotinas​:
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Outras Observações
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Disponibilidade de horário
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TRATAMENTO - PLANO DE INTERVENÇÃO

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 Exame Objectivo

Observação
Postura
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Pele
Coloração:_______________________________ Tª: _______________________ Textura:____________________________
Hidratação: ___________________________________________ Sudação:________________________________________

Cicatrizes:
Localização____________________________________________________________________________________________
Comprimento ______________________ Aderências __________________________ Coloração ______________________

Edema _​ ______________________________________________________________________________________________
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Palpação
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Mobilidade

Movimentos Activos
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Movimentos Passivos
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Movimentos Acessórios
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Força Muscular
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Marcha
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Equilíbrio
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OBSERVAÇÕES
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Fisiolar - Saúde ao Domicílio Web: ​www.fisiolar.​pt Email: ​info@fisiolar.pt​ (+351) 212 841 984