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HOJA DE EVALUACION DE FISIOTERAPIA

Datos Personales
NOMBRE: ______________________________________________EDAD: ___
SEXO: ___ Diagnostico: _____________OCUPACION: _________ FECHA: ___
HISTORIA CLINICA
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EVALUACION FISICA:
Actitud Postural: Normal____ Alterada_____
Evaluacin de piel: Color: Normal_____ Erimatosa____ Equimosis____
Estado: Normal___ Seca: _____ Brillante: _____
Edema: Ninguno____ Leve: _____ Moderada____ Severo_____
Evaluacin de dolor:
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Evaluacin de la sensibilidad: Superficial_______________ Profunda__________
Evaluacin
Osteoarticular:___________________________________________________________
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Evaluacin neuromuscular:
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Padece una enfermedad: ___________________________________________________
PLAN DE TRATAMIENTO:
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