FUNDACION UNIVERSITARIA MARIA CANO

FACULTAD CIENCIAS DE LA SALUD

PROGRAMA DE FISIOTERAPIA

VALORACIÓN OSTEOMUSCULAR

FECHA: N° DE DOCUMENTO: NIVEL EDUCATIVO:

NOMBRE Y APELLIDO: EDAD: PRACTICA ACTIVIDAD FISICA:

FECHA DE NACIMIENTO: OCUPACIÓN: CREENCIAS RELIGIOSAS:

ÁREA DE TRABAJO: ANTIGÜEDAD: VINCULACIÓN:

ESTADO CIVIL: DIRECCIÓN: EPS:

SEXO: NÚMERO DE TELÉFONO FIJO: NÚMERO DE TELÉFONO CELULAR:

ANTECEDENTES PERSONALES: No refiere (NR).

HÁBITOS:

PATOLÓGICOS:

TRAUMÁTICOS:

FARMACOLÓGICOS:

QUIRÚRGICOS:
 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
LABORALES:

FAMILIARES:

GINECOSTETRICOS:

REMISIÓN MEDICA A ESCUELA:

DIAGNÓSTICO MÉDICO:

MOTIVO DE CONSULTA:

ATRIBUCION DE SINTOMATOLOGIA:

REVISION POR SISTEMAS

CARDIO PULMONAR:
PRESION ARTERIAL: ________ FRECUENCIA CARDIACA: _________ FRECUENCIA RESPIRATORIA: __________

NEUROMUSCULAR:

Alerta atención cognición __________________ Comunicación: _____________________

MUSCULOESQUELETICO:

Screening muscular__________________________________________________________

Screening articular __________________________________________________________

Marcha locomoción y balance: ________________________________________________

TEGUMENTARIO:

Propiedades físicas y mecánicas de la piel:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
EXAMEN:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
EVALUACION

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

CONCEPTO FISIOTERAPEUTICO

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

PRONOSTICO Objetivo general

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

PLAN DE INTERVENCION
 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
PLAN DE INTERVENCION

OBJETIVO ESPECIFICO MEDIO O TECNICA RESPUESTA FISIOLOGICA PRESCRIPCION

 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
OBJETIVO ESPECIFICO MEDIO O TECNICA RESPUESTA FISIOLOGICA PRESCRIPCION

_________________________________________________

EVALUADOR
 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
NOTAS DE EVOLUCION

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
 FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
FUNDACION UNIVERSITARIA MARIA CANO
FACULTAD CIENCIAS DE LA SALUD
PROGRAMA DE FISIOTERAPIA