70
primeiras palavras:_____________________
Outros problemas:__________________________________
controle urinário diurno:________________
controle urinário noturno:________________
Comentários:_______________________________________
controle fecal:_________________________
nício escola ou creche:__________________
ISDA:
Olhos:___________________________________________________________________________________
Nariz:___________________________________________________________________________________
Oro-faringe:_____________________________________________________________________________
________________________________________________________________________________________
Orelhas:_________________________________________________________________________________
SNC:___________________________________________________________________________________
S.Respiratório:____________________________________________________________________________
________________________________________________________________________________________
S.Cardiovascular:__________________________________________________________________________
________________________________________________________________________________________
S.Digestivo:______________________________________________________________________________
________________________________________________________________________________________
S.Endócrino:_____________________________________________________________________________
Neuropsíquico (humor, memória, atenção, distúrbio escolar ou profissional):
________________________________________________________________________________________
Sexual:__________________________________________________________________________________
S.Osteomuscular:__________________________________________________________________________
Pele, anexos e
subcutâneo:________________________________________________________________
S.Gênito-urinário:__________________________________________________________
VACINAÇÃO:__________________________________________________________________________
EXAME FÍSICO:
Peso_____________ Altura______________ IMC_________ P/E_____________PC__________
Perímetro cervical _______ PA________ Pulso________ FC______ FR_____ Temperatura______
Segmento cefálico :
Face____________________________________________________________________________________
Orofaringe_______________________________________________________________________________
Dentes__________________________________________________________________________________
Olhos:___________________________________________________________________________________
Nariz:___________________________________________________________________________________
Otoscopia:_______________________________________________________________________________
Pescoço_________________________________________________________________________________
Tórax: _________________________________________________________________________________
Coração:_________________________________________________________________________________
Pulmões:________________________________________________________________________________
Abdômen:_______________________________________________________________________________
Fígado______________________________________
baço:__________________________________________
Osteomuscular:___________________________________________________________________________
Endócrino:_______________________________________________________________________________
Psíquico:________________________________________________________________________________
________________________________________________________________________________________