EVALUACION DE FISIOTERAPIA

UNIVERSIDAD RAFAEL LANDVAR

Nombre Del Paciente:

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Fecha de evaluacin: Fecha De Nacimiento: _______________________

Lateralidad: Derecho Izquierdo

Diagnstico Mdico: ________________________________________________________

Gnero: Masculino Femenino Edad: ______ Ocupacin: __________________

Historia Clnica:
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Antecedentes personales

Patolgicos:_______________________________________________________________
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Quirurgicos:_______________________________________________________________
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Traumaticos:_______________________________________________________________
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Sensibilidad:____________________________________________________________________________________
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Dolor: Si No Tipo de Dolor: Constante Intermitente

Intensidad (1-10): __________________________________________________________

Descripcin del Dolor:

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 EVALUACION DE FISIOTERAPIA
UNIVERSIDAD RAFAEL LANDVAR
Evaluacin Postural

Vista anterior:
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Vista lateral:
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Vista posterior:
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Examen muscular:
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Equilibrio:
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Arco de movimiento articular:

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 EVALUACION DE FISIOTERAPIA
UNIVERSIDAD RAFAEL LANDVAR
 EVALUACION DE FISIOTERAPIA
UNIVERSIDAD RAFAEL LANDVAR
 EVALUACION DE FISIOTERAPIA
UNIVERSIDAD RAFAEL LANDVAR
 EVALUACION DE FISIOTERAPIA
UNIVERSIDAD RAFAEL LANDVAR

Marcha:
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Medicamentos: Si No Cual: __________________________________________

Horario: _________________________ Dosis: ___________________________________

Movilidad/Accesorios:
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Diagnostico Fisioteraputico:
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Observaciones:
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Fecha de Evaluacin: __________________________________________

Evaluador: __________________________________________

Firma: __________________________________________
 EVALUACION DE FISIOTERAPIA
UNIVERSIDAD RAFAEL LANDVAR
Evaluacin Movimiento Articular
Nombre del paciente: _______________________________________________________

Edad: _________________________Genero: __________________ Fecha: ____________

Diagnostico Medico: ________________________________________________________

MIEMBRO SUPERIOR
 EVALUACION DE FISIOTERAPIA
UNIVERSIDAD RAFAEL LANDVAR
MIEMBRO INFERIOR