[Digite seu

Avenida
LIZANDRA SOARES GARCIA
ANAMNESE INFANTIL
IDENTIFICAO

Brasil,
endereo]
NOME:_______________________________________________________________
DATA DE NASCIMENTO: / / IDADE ATUAL:

353, Ivinhema
PRONTURIO N _________
ME: ________________________________________________________________

[Digite seu
PAI: _________________________________________________________________
ENDEREO:__________________________________________________________

- MS
CONTATO:___________________________________________________________
INFORMANTE: DATA: / /

telefone]
67 9677-7741
QUEIXA

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67 9259-3421
endereo deemail]
HISTRIA PREGRESSA QUEIXA
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lizadra_garcia@hotmail.com
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ANTECEDENTES CLNICOS
A) FAMILIARES:
Algum da famlia apresenta o mesmo problema?
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Alguma deficincia na famlia?
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B) MATERNOS:
Me apresenta algum problema de sade?
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Vcios?
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C) GESTACIONAIS:
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D) FASE NEO NATAL:

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E) FASE PS NATAL:
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DESENVOLVIMENTO GLOBAL
A) DESENVOLVIMENTO MOTOR
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B) DESENVOLVIMENTO OROMOTOR
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C) RESPIRAO
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D) MASTIGAO
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E) DEGLUTIO
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F) DESENVOLVIMENTO DA LINGUAGEM
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G) COMUNICAO ATUAL
G1. EXPRESSIVO
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G2. RECEPTIVO
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G3. OUTRAS PESSOAS COM A CRIANA
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HBITOS DELETRIOS
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TRATAMENTOS REALIZADOS
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EXAMES REALIZADOS
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ASPECTOS COMPORTAMENTAIS
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QUALIDADE DO SONO
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ACUIDADE/ ATENO AUDITIVA E VISUAL

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MEDICAMENTOS
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OBSERVAO

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Lizandra Soares Garcia Fonoaudiloga
CRf 6 - 7156/MS