CIF NEURO

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Avaliação Funcional - CIF Data: / / 
 
 
 Paciente: 
Expectativa do paciente: Condição de saúde: 
 
 
Percepção do 
paciente / 
família em 
relação a 
condição de 
saúde / 
 incapacidade 
 
 
 
 
Levantamento 
pelo 
fisioterapeuta 
de fatores 
objetivos 
relacionado às 
queixas 
Estrutura e função corporal Atividade Participação 
 
 Fatores contextuais 
Fatores pessoais: Fatores ambientais: 
 
Descrever os componentes ausentes e/ou as adaptações utilizadas na 
atividade que está limitada: 
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Diagnóstico Fisioterapêutico: 
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Objetivo Funcional do Tratamento: 
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Plano de Tratamento: 
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Orientações Domiciliares: 
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 Assinatura do aluno: _______________________________________