
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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