FACULDADE INTEGRADA CETE – FIC

CENTRO DE ASSISTÊNCIA INTEGRAL E SOCIAL – CAIS

CLÍNICA ESCOLA DE FISIOTERAPIA - CLINFISIO

FICHA DE AVALIAÇÃO FISIOTERAPÊUTICA ORTOPEDIA E TRAUMATOLOGIA

1 – IDENTIFICAÇÃO

Nome: _________________________________________________________________

Idade: __________________ D.N _______________ Sexo: ________

Endereço: ______________________________________________________________

Telefone: _____________________________

Estado Civil: ___________________________ Profissão: ________________________

Médico Responsável: _____________________________________________________

Data de Admissão: ________________

DIAGNÓSTICO CLÍNICO: ___________________________________________________

2 – ANAMNESE

SINAIS VITAIS:

PA: _________________ SATURAÇÃO DE O2 ________________

BATIMENTOS CARDÍACOS: _________ PADRÃO RESPIRATÓRIO: ___________________

HISTÓRICO FAMILIAR:

( )H.A.S ( )CARDIOPATIA ( )DIABETES

OUTROS: _______________________________________________________________

HISTÓRICO PESSOAL:

( )TABAGISMO ( )SEDENTARISMO ( ) CARDIOPATA ( )DIABETES

OUTROS: _______________________________________________________________

Q.P: ___________________________________________________________________

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DESCRIÇÃ0 DA DOR: ______________________________________________________

H.D.P:

( )CIRURGIA ( )FISIOTERAPIA ( )USO DE MEDICAMENTOS

 FACULDADE INTEGRADA CETE – FIC
CENTRO DE ASSISTÊNCIA INTEGRAL E SOCIAL – CAIS
CLÍNICA ESCOLA DE FISIOTERAPIA - CLINFISIO

H.D.A:

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3- EXAME FÍSICO

INSPEÇÃO:

POSTURA:___________________________________________________________________________
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MARCHA: ______________________________________________________________

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PELE: __________________________________________________________________

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TROFISMO E TÔNUS ______________________________________________________

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DEFORMIDADES: ________________________________________________________

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EDEMA: _______________________________________________________________

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ERITEMA, EQUIMOSE: ____________________________________________________

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PALPAÇÃO

ÁREAS DOLOROSAS ( ) NÃO ( ) SIM ______________________________________

CREPITAÇÃO ( )NÃO ( )SIM ______________________________________________

 FACULDADE INTEGRADA CETE – FIC
CENTRO DE ASSISTÊNCIA INTEGRAL E SOCIAL – CAIS
CLÍNICA ESCOLA DE FISIOTERAPIA - CLINFISIO
TEMPERATURA:
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TENSÃO MUSCULAR ______________________________________________________

PERIMETRIA:

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GONIOMETRIA:

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MOBILIDADE ARTICULAR:

- ATIVA:
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- PASSIVA:

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FORÇA MUSCULAR:

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TESTES ESPECIAIS:
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EXAMES COMPLEMENTARES:
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 FACULDADE INTEGRADA CETE – FIC
CENTRO DE ASSISTÊNCIA INTEGRAL E SOCIAL – CAIS
CLÍNICA ESCOLA DE FISIOTERAPIA - CLINFISIO
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PROBLEMAS:

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OBJETIVOS DO TRATAMENTO:

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TRATAMENTO FISIOTERAPÊUTICO:

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ORIENTAÇÕES:

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Acadêmicos
 FACULDADE INTEGRADA CETE – FIC
CENTRO DE ASSISTÊNCIA INTEGRAL E SOCIAL – CAIS
CLÍNICA ESCOLA DE FISIOTERAPIA - CLINFISIO
___________________________________ Preceptor

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