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Por:   •  15/4/2015  •  Trabalho acadêmico  •  464 Palavras (2 Páginas)  •  159 Visualizações

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CENTRO UNIVERSITÁRIO[pic 1]

INSTITUTO DE EDUCAÇÃO SUPERIOR DE BRASÍLIA – IESB

           Docente: Cristina Brolhan                    Turno: Noturno

           Discente: Raissa Lorena                      Matrícula: 13211120104

                                         Roteiro de Anamnese

Data do atendimento: ____________________________________________________

Identificação:

Nome:___________________________________________________________________

Idade: __________Sexo: _________________ Nacionalidade: ______________________

Estado Civil: ____________________ Data de nasc.:______________________________

Grau de instrução:__________________________________________________________

Profissão:________________________________________________________________

Residência (cidade/estado): __________________________________________________

Telefones para contado: _____________________________________________________

Atendimento:

Frequencia:___________________________ Data/hora:___________________________

Queixa Principal:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Secundária:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Sintomas:

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Histórico da Doença Atual:

Início da patologia:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Frequência:_______________________________________________________________________________________________________________________________________

Intensidade:______________________________________________________________

Tratamentos anteriores: ____________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________

Medicamentos:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Histórico Pessoal:        

Infância:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Rotina___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Vícios:__________________________________________________________________________________________________________________________________________________________________________________________________________________

Hobbies:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

...

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