Formulário de Exame Físico

EXAME FÍSICO

 

Peso atual________________  Percentil/Escore Z: ________     Estatura atual_______________   Percentil/Escore Z: __________

 

Perímetro cefálico atual____________ Percentil/Escore Z: ________                   IMC __________ Percentil/Escore Z: __________

 

Sinais Vitais: Temperatura Axilar ______°C        Pulso (FC) :_________BPM        FR: ______IRPM          PA_____X______ mmHG

 

Inspeção geral/Ectoscopia ___________________________________________________________________________________

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Pele: _______________________________________________________________________________________________________

Linfonodos __________________________________________________________________________________________________

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Aparelho Respiratório ________________________________________________________________________________________

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Aparelho cardiovascular ______________________________________________________________________________________

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Abdome ____________________________________________________________________________________________________

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Genitália/região anorretal ____________________________________________________________________________________

Membros ___________________________________________________________________________________________________

Otoscopia___________________________________________________________________________________________________

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Oroscopia___________________________________________________________________________________________________

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Neurológico  ________________________________________________________________________________________________

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Outros dados clínicos relevantes ______________________________________________________________________________

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DIAGNÓSTICOS

 

Diagnóstico(s) clínico (s) (Hipóteses, diagnósticos diferenciais) __________________________________________________

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Pôndero-estatural / Nutricional_______________________________________________________________________________

Desenvolvimento Neuropsicomotor___________________________________________________________________________

Estado Vacinal______________________________________________________________________________________________

 

 

CONDUTA

 

Solicitação de Exames complementares ________________________________________________________________________

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Pedidos de parecer __________________________________________________________________________________________

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Prescrição da dieta ___________________________________________________________________________________________

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Prescrição de Medicamentos _________________________________________________________________________________

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OBSERVAÇÕES

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