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  • LW Sws LK IYq QAMYPUm Fxxu HHUlk CTM EZBY0 Qeh SW J

    Enviado por

    Elisama Aquino
    6 visualizações3 páginas

    Título original

    lwSwsLkIYqQAMYPUmFxxuHHUlkCTmEZBY0qehSwJ(1)

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    © © All Rights Reserved

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    © All Rights Reserved
    Baixe no formato DOCX, PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    6 visualizações3 páginas

    LW Sws LK IYq QAMYPUm Fxxu HHUlk CTM EZBY0 Qeh SW J

    Enviado por

    Elisama Aquino

    Direitos autorais:

    © All Rights Reserved
    Baixe no formato DOCX, PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    de 3

    Nome Completo:____________________________________________________________

    Data de Nascimento:_________________ Idade: _________

    Sexo:___________________________

    Motivo da consulta: _______________________________________

    Queixa principal

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

    História da doença atual

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
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    Atividade Física

    ⃝ Sedentário ⃝ 1-3x/semana ⃝ >3x/semana

    Tipo de atividade

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    Exames realizados

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

    ⃝ Tabagismo ⃝ Etilismo ⃝ Diabetes

    Trabalhos realizados

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

    Exame físico

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
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    História Familiar

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

    Orientações
    TVP

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    HAS

    ⃝ Controlada ⃝ Moderada > 140mmhg ⃝ Grave > 180 mmhg

    Exames solicitados

    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

    Medicações em uso

    Medicamento Dose

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