50677825-ficha-de-anamnese-em-auriculoterapia.doc

FICHA DE ANAMNESE EM AURICULOTERAPIATerapeuta ________________________________________________________Paciente______________________________________________________________________Endereo______________________________________________________________________Telefone Res. __________________ Trabalho___________________ Cel _________________E-mail _______________________________________________________________________Nascimento ______/________________19_______ Idade _______ Profisso _________________________________________ ! "#antos anos$ ________%oti&o's( da )roc#ra deste tratamento*Como che+o# a n,s$'( indicao de ami+os '( )anfletos '( -! . cliente'( o#tros/lt#ra____________ Peso __________0+ 1bs.*_________________________2 diab.tica$ _____ Est! +r!&ida$ ____2 card3aca$ ______ 4ofre de )resso alta$ ______5sa marca )asso$ ____5sa anti de)ressi&os$ _____6#ma$ _____5sa anal+.sicos fortes$ _____ 7ebidas alco,licas$ '( no '( com fre"89ncia '( )o#co:oena cr;nica$ 'h! m#ito tem)o( _________________________________________________:oenas na fam3lia$ ____________________________________________________________:or de cabea forte e constante$ ___1#tra dor$______________________________________4ente dores nos ossos$ _____ nas artic#laerc3cios f3sicos$ ____ 7ebe bastante !+#a$ _____?ida estressada$ __________Como se alimenta$'( )o#co'( ra=o!&el '( m#ito '( mais do "#e de&eriaCom "#e "#alidade$ '( mal'( re+#lar '( boa'( me alimento m#ito bem@#e ti)o de rem.dio esta #sando a+ora$ Por receita do m.dico$ ______Com "#e ob-eti&o$ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________R57RIC/ :1 TER/PE5T/ /44IN/T5R/ :1 P/CIENTECONSULTA N-:ata ___/___/____ ora* ___*___ Presso arterial* _____> _____Pontos a)licados Observaes sbre a PA _____________1b-eti&os desta a)licao*_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________R57RIC/ :1 TER/PE5T/ /44IN/T5R/ :1'/( P/CIENTE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!CONSULTA N -:ata ___/___/____ ora* ___*___ Presso arterial* _____> _____Pontos a)licadosObservaes sbre a PA______________Res)osta cl3nica do )aciente a a)licao anterior*_______________________________________________________________________________________________________________________________________1b-eti&os desta a)licao*_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________R57RIC/ :1 TER/PE5T/ /44IN/T5R/ :1'/( P/CIENTE