Anamnese Adulto

Data do atendimento: _____/_____/_____

Dados pessoais:

Nome: _________________________________________________________________
Idade: ___________ Sexo: _________________ Nacionalidade: ___________________
Estado civil: ________________________Data de nasc.: _________________________
Grau de instrução:
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Profissão: ______________________________________________________________
Residência (cidade/estado): ________________________________________________
Telefones para contato:
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Atendimento:

Frequência: ______________________________ Data/Hora: _____________________

Principal queixa:
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Queixas secundárias:
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Sintomas:
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Histórico da doença atual:

Quando e como iniciou?
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Frequência:
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Intensidade:
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Tratamentos anteriores:
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Medicamentos:
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Histórico pessoal:

Infância:
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Rotina dia a dia:

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Vícios:
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Hobbies:
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Trabalho:
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Histórico familiar:
Pais:
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Irmãos:
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Cônjuge:
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Filhos:
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Lar:
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História patológica:
Doenças anteriores (enfermidades e tratamentos anteriores, incluindo doenças,
alergias, lesões, cirurgias, procedimentos e hospitalizações anteriores, bem como
medicamentos utilizados e vacinas tomadas):
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Exame psíquico:
Qual a aparência do paciente? (Corresponde a descrição física do paciente: roupa,
presença ou não de adornos, cabelos, higiene e autocuidado do paciente)
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Como o paciente se comporta? (Esse fator diz respeito à relação e atitude diante do
profissional. Quem está realizando o exame deve dizer se o paciente se encontra
cooperante, indiferente, passivo, fóbico, agressivo, petulante, cabisbaixo, dissimulado,
etc. É importante relatar qual foi a situação que o levou a chegar à essa conclusão.)

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