Ficha de Avaliação Ortopedia

FICHA DE AVALIAO: FISIOTERAPIA EM ORTOPEDIA E TRAUMATOLOGIA
Data da avaliao? ___/___/___

Nome:___________________________________________________
Nascimento:___/___/___ Idade: _______ Sexo: ( ) M ( ) F Estado Civil: ________________
Profisso: ______________________ Cidade _____________________
Bairro: _______________________________ Telefone (__)______________
SINAIS VITAIS
P.A: _____________ F.C: _____________ F.R _______________
HISTRIA CLNICA
QUEIXA PRINCIPAL:
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EXPECTATIVA:
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HMA:
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HF:
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EXAME FSICO
INSPEO:
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PALPAO:
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AVALIAO POSTURAL (ANTERIOR / POSTERIOR / LATERAL)
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EXAME DE MOVIMENTO:
Ativo geral:
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Passivo:
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MOVIMENTOS ACESSRIOS:
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TESTES FUNCIONAIS:
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TESTES ESPECIAS:
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EXAMES COMPLEMENTARES:
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DIAGNSTICO CINTICO FUNCIONAL:
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OBJETIVOS DO TRATAMENTO FISIOTERAPUTICO:

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CONDUTAS FISIOTERAPUTICAS:
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ACADMICAS:
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SUPERVISOR: _____________________________________________________________

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Ficha de Avaliação Ortopedia

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FICHA DE AVALIAO: FISIOTERAPIA EM ORTOPEDIA E TRAUMATOLOGIA

Data da avaliao? _/_/___

OBJETIVOS DO TRATAMENTO FISIOTERAPUTICO:

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