Ficha de Avaliacao ASD

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FISIOTERAPIA DESPORTIVA – ATLETA SEM DOR 
 
Nome:______________________________________________________________________________________ 
Idade:_____________________ Data de Nascimento:_____/_____/__________ Sexo:______________________ 
Esporte praticado: ____________________________________________________________________________ 
Endereço: ___________________________________________________________________________________ 
Bairro:_______________________________________ Cidade: _______________________________________ 
Telefone: _______________________________ Estado Civil: ________________________________________ 
Médico Responsável:_________________________________________________________________________ 
Diagnóstico Clínico: __________________________________________________________________________ 
 
Anamnese 
 
Queixa Principal: ____________________________________________________________________________ 
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História da Moléstia Atual 
 
Data da Lesão ou início dos sintomas: ____________________________________________________________ 
 
Local da Lesão ou dos sintomas:________________________________________________________________ 
 
Mecanismo de Lesão:_________________________________________________________________________ 
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O atleta continuou a atividade após a lesão:_________________________________________________________ 
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Conduta tomada logo após a lesão: _______________________________________________________________ 
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Tipos de sintomas apresentados pelo atleta: ________________________________________________________ 
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Intensidade dos sintomas:______________________________________________________________________ 
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Características dos sintomas:____________________________________________________________________ 
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Nível de atividade atual:_______________________________________________________________________ 
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História da Moléstia Pregressa 
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MINISTÉRIO DA EDUCAÇÃO 
Universidade Federal de Alfenas. UNIFAL-MG 
Av. Jovino Fernandes Sales, 2600. Unidade II - Santa Clara 
Alfenas/MG. CEP 37130-000 
Fone: (35) 3701-1900 
 
CURSO DE FISIOTERAPIA 
 
Medicamentos Utilizados 
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Exame Físico 
 
Inspeção 
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Palpação 
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Movimentação (ativo/passivo) 
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Sensação Final de Movimento 
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Movimento acessório 
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Avaliação de ADM 
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Avaliação Muscular 
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Comprimento Muscular (Flexibilidade) 
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Perimetria 
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Avaliação Postural 
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Avaliação da Marcha 
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Avaliação Neurovascular 
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Testes Especiais 
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Exames Complementares 
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Diagnóstico Fisioterapêutico 
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Objetivos do Tratamento 
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Condutas 
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Data:______/_____/__________ 
 
Estagiário (nome por extenso):_______________________________________________________________ 
 
Supervisor:______________________________________________________________________________ 
 
OBS: 
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