FICHA DE AVALIAÇÃO

ESTÁGIO-FISIOTERAPIA
HOSPITALAR

Nome:_____________________________________________________________________________________________
Leito:____________________Registro_____________Data da Internação:___/___/___Data da Avaliação:___/___/___
Idade:_________________Sexo:___________________________________Profissão:____________________________
Médico Responsável:_________________________________________________________________________________
Diagnóstico Clínico:__________________________________________________________________________________
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Diagnóstico Fisioterapêutico:__________________________________________________________________________
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HMA:______________________________________________________________________________________________
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HMP:______________________________________________________________________________________________
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CHV:______________________________________________________________________________________________
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Exames Complementares:
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Medicações:_________________________________________________________________________________________
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Exame Físico - Inspeção:______________________________________________________________________________
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Dados Vitais: FR _____________ FC________________PA _____________SAT_______________TEMP___________
Avaliação Respiratória:______________________________________________________________________________
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Avaliação Motora: ___________________________________________________________________________________
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Avaliação Neurológica:
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Avaliação Circulatória:_______________________________________________________________________________
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Objetivos de Tratamento:_____________________________________________________________________________
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Prescrição do tratamento:
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Acadêmico Responsável: _____________________________________________________________________________
 EVOLUÇÃO

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