FICHA CLÍNICA Datos personales: Nombre: ______________________________________________________________ Edad: ________________________________________________________________ Hijos: ________________________________________________________________ Dirección: _____________________________________________________________ Fono: ________________________________________________________________Profesión: _____________________________________________________________ Diag Medico: __________________________________________________________ Fecha de ingreso: ______________________________________________________ Fecha de Alta: _________________________________________________________ Exámenes: _________________________________________________________________________________________________________________________________ Medicamentos: _________________________________________________________ _____________________________________________________________________ Anamnesis Remota: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________Anamnesis Próxima: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Evaluación Física: Dolor: ________________________________________________________________ Observación:_____________________________________________________________________ _____________________________________________________________________ ____________________________________________________________________ Inspección: Piel: _________________________________________________________________ Edema: _______________________________________________________________ Hematoma:___________________________________________________________ Vendaje: _____________________________________________________________ Cicatriz: ______________________________________________________________ Ulceras: ______________________________________________________________ Vía externa: ___________________________________________________________ Palpación: Tº corporal:___________________________________________________________ Puntos dolorosos: ______________________________________________________ Contracturas: __________________________________________________________ Acortamientos musculares: _______________________________________________ Tono muscular: ________________________________________________________ Trofismo muscular: _____________________________________________________ Sensibilidad profunda(presión o dolor): _____________________________________ Sensibilidad superficial (tacto): ____________________________________________ Sensibilidad a temperaturas (frío-calor): ____________________________________ Movimientos de fasias: __________________________________________________ Test de rasguño: _______________________________________________________ Movimientos vertebrales:________________________________________________ Tórax (rígido-flexible): __________________________________________________
Evaluación postural: _____________________________________________________________________ _____________________________________________________________________ __________________________________________________________________________________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Pruebas especiales pertinentes: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________...
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