Ficha de Avaliao Fisioteraputica: Motora e Respiratria Peditrica

DADOS DA CRIANA:
Nome:_____________________________________________________
Data de nasc.:__/__/____ Sexo:____ Id. cronolgica:______
Local de nascimento:____________
Apgar: 1 min.____

Id. corrigida:________

Peso ao nascer:_______ Peso atual:_______

5 min.____

DADOS DA ME:
Nome:______________________________________________________
Data de nasc.:__/__/____ Idade:______
Ocupao:_________________ Escolaridade:__________________________
Etilista:______

Tabagista:______

Drogas:_____________________________

DADOS DO PARTO:
Descrever tipo de parto bem como se houve intercorrncias:

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OBSERVAES GERAIS:
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AVALIAO DA CRIANA:

Colorao:_______________ FR:______ FC: ______ SpO2: _______

Ausculta pulmonar:_____________________________________

Esforo respiratrio: ____________________________________

Tnus: ____________________________________________

Refexos primitivos: _____________________________________

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Posio viciosa: _______________________________________

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Limitaes de ADM:_____________________________________
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Fora muscular: _______________________________________

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Marcos motores:_______________________________________
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Equilbrio: __________________________________________

Postura (realiza troca): ___________________________________

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Marcha:___________________________________________
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DIAGNSTICO FISIOTERAPUTICO:
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OBSERVAES:
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