FICHA DE AVALIAÇÃO EM REUMATOLOGIA | REUMATO | FISIOTERAPIA

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UNIVAG - Centro Universitário de Várzea Grande 
Clínica Integrada - Fisioterapia 
Ficha de Avaliação em Reumatologia 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Identificação 
Nome:___________________________________________________________________ 
CPF:______________________________ Data de Nascimento:__/__/__ 
Idade:_______________ Sexo: ( ) Feminino ( ) Masculino 
Cor/Raça: ( ) Branca ( ) Negra ( ) Amarela ( ) Parda ( ) Indígena 
Naturalidade:______________________________________________________________ 
Nacionalidade:_____________________________________________________________ 
Estado Civil: _________________________ Profissão:____________________________ 
Endereço:___________________________________ Cidade:_______________________ 
Bairro:________________________________ CEP: ______________________________ 
Telefone:___________________________ Celular:_______________________________ 
Início do tratamento:____________________________________________ 
Término do tratamento: _________________________________________ 
Necessita de acompanhante: ( ) Sim ( ) Não 
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Fisioterapeuta Responsável 
 
Data da Avalição: __/__/__ 
 
Avaliação Clínica 
Patologia Concomitante: ___________________________________________________________________ 
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Exames Subsidiários: _____________________________________________________________________ 
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Antecedentes cirúrgicos: ___________________________________________________________________ 
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Medicamentos: ___________________________________________________________________________ 
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Dados mórbidos: _________________________________________________________________________ 
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Tabagismo: ( ) Sim ( ) Não ( ) Ex-fumante __________________________________________________ 
Etilismo: ( ) Sim ( ) Não __________________________________________________________________ 
Anamnese:________________________________________________________________________
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Queixa Principal: _________________________________________________________________________ 
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Queixa Geral (sintomas): __________________________________________________________________ 
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Mais frequente: ( ) Manha ( ) Tarde ( ) Noite Tempo de duração:_________________________________ 
Faz uso de medicamentos para tratar estes sintomas:______________________________________________ 
Alteração nas Atividades Diárias: ____________________________________________________________ 
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Avaliação Clínica 
 Sinais Vitais 
Frequência Respiratória:_______________ 
Frequência Cardíaca:__________________ 
Pressão Arterial Sistêmica:______________ 
Temperatura: ________________________ 
 
Inspeção 
Palpação: ______________________________________________________________________________________ 
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Tônus Muscular:_________________________________________________________________________________ 
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Trofismo: _____________________________________________________________________________________ 
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Alteração Articular: ______________________________________________________________________________ 
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Marcha: ( ) Normal ( )Alterada 
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IMC: __________________________________ 
Peso: __________________________________ 
Altura: _________________________________ 
 Avaliação Clínica 
Avaliação Postural: _______________________________________________________________________________ 
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ADM Passiva 
( ) Hiperextensibilidade 
( ) Normoextensibilidade 
( ) Hipoextensibilidade 
( ) Extensibilidade 
 
 
ADM Ativa 
( ) Presente e normal 
( ) Presente e diminuída 
( ) Ausente 
 
 
 
Avaliação Clínica 
Dor: 
 
Frequência e intensidade da dor: 
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Características: ( ) Queimação ( ) Constrição ( ) Compressão ( ) Peso ( ) Agulhada ( ) Pontadas ( ) Piora ao respirar 
( ) Outra ______________________________________________________________________________________ 
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 Mais frequente: ( ) Manha ( ) Tarde ( ) Noite 
Faz uso de algum procedimento/ medicamento para alívio da dor: __________________________________________ 
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Articulações:_________
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Membros/ Músculos: 
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 Avaliação Clínica 
 
Observação: _________________________________________________________________________________ 
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 Esforço ao realizar as atividades diárias: 
 
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Avaliação Clínica 
Diagnostico Fisioterapêutico: 
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Objetivo do tratamento fisioterapêutico: 
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Orientações:________________________________________________________________________________
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Observações:_______________________________________________________________________________
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Data da Avaliação: __/__/__ Data da Alta: __/__/__ 
Início do tratamento: __/__/__ Término do tratamento:__/__/__ 
 
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Paciente 
 
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Fisioterapeuta 
 
 
 
 
Trabalho Realizado por: Cristina Venson