Ficha de Avaliação de Traumato-Ortopedia-Reumato

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UNIVERSIDADE SALGADO DE OLIVEIRA 
CLÍNICA ESCOLA DE FISIOTERAPIA 
 
AVALIAÇÃO EM TRAUMATO-ORTOPEDIA E REUMATO 
 
1- DADOS PESSOAIS Data: ______/______/_____ 
 
Nome____________________________________________________Nascimento: _______________ 
Endereço:_____________________________________________________Cidade: ______________ 
Bairro: ________________________ CEP: ___________/______ Tel: _______________________ 
Celular:________________CPF:__________________________RG:__________________________ 
Peso: ___________Altura:_____________Ativ. Profis.:_____________________________________ 
 
2- AVALIAÇÃO 
SINAIS VITAIS: P.A. _____________ Pulso: ________ F.R. _________ Temp. Corp. _________ 
DIAGNÓSTICO CLÍNICO: __________________________________________________________ 
Fisiodiagnóstico: ____________________________________________________________________ 
QP.:_______________________________________________________________________________ 
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H.D.A./H.P.P:_______________________________________________________________________
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H. FAMILIAR:_____________________________________________________________________ 
 
 
Problemas Médicos(Cirurgias, medicamentos, acompanhamento psicológico, pato pré-existente): 
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EXAMES COMPLEMENTARES (RX,TC,US,RNM): 
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Grau de força muscular____________( 0 a 5 ) 
 Escala de dor: 
0 1 2 3 4 5 6 7 8 9 10 
 
 
Inspeção:___________________________________________________________________________
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Palpação:___________________________________________________________________________
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Goniometria/Perimetria:______________________________________________________________
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Testes físicos:_______________________________________________________________________ 
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Obs.:_______________________________________________________________________________ 
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3-Objetivos do Tratamento:___________________________________________________________ 
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4-Procedimentos:____________________________________________________________________ 
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_________________________________ ______________________________ 
 ACADÊMICO SUPERVISOR (A) 
	UNIVERSIDADE SALGADO DE OLIVEIRA
	Nome____________________________________________________Nascimento: _______________
	Inspeção:______________________________________________________________________________________________________________________________________________________________