AVALIAÇÃO DE ORTOPEDIA 200

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FICHA DE AVALIAÇÃO
ORTOPEDIA E TRAUMATOLOGIA 
Data: / /
	DADOS PESSOAIS
	Nome:
	Idade:
	Sexo:
	Raça:
	Estado civil:
	Profissão:
	Endereço:
	Diagnóstico médico:
	ANAMNESE
	Queixa principal
	
	
	História da doença atual
	
	
	
	
	
	
	
	História da doença pregressa
	
	
	
	
	História Social
	
	
	
	
	
	
	Exames Complementares
	
	
	
	
	
	
Sinais Vitais
PA: __________________________ 
FC: __________________________
FR: __________________________
	Exame Físico
INSPEÇÃO:
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Tipo de Marcha:_____________________________________________________________________
PALPAÇÃO
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
GONIOMETRIA
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
PERIMETRIA
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
FORÇA MUSCULAR
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
	Testes especiais de ortopedia
	
	
	
	
	
	
	
	
	
	Diagnóstico fisioterapêutico:
	
	
	
	Objetivos de tratamento:
	
	
	
	
	
	
	
	
	
	
	
	Conduta de tratamento:
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
________________________ ________________________
Acadêmico Acadêmico
__________________________
Professor