SEDE ORURO

CARRERA DE FISIOTERAPIA

FICHA DE EVALUACIÓN KINESICA DEL AREA DE NEUROLOGIA

NEURALGIA POST HERPETICA

I. FILIACIÓN

Nombre del paciente:..........................................................................................................

Edad:........................... Sexo: ……………. Ocupación:...................................................
Domicilio:...........................................................................................................................
Fecha de evaluación:..........................................................................................................
Nombre del Fisioterapeuta:.............................................................................................
Diagnostico medico:..........................................................................................................
Centro de rote: ………………………………………………………………………………………

II. ANAMNESIS

MOTIVO DE CONSULTA
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ANTECEDENTES PATOLOGICOS
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III. EVALUACIÓN KINESICA - FISICA

a) Inspección:

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b) Palpación:
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c) Evaluación del dolor

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D) Evaluación de la postura
Anterior
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Posterior.
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Lateral
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e) Evaluación de la sensibilidad

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IV. DIAGNOSTICO FISIOTERAPEUTICO KINESIOLOGICO
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V. OBJETIVOS DE TRATAMIENTO
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VI. PLAN DE TRATAMIENTO

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VII. PRONOSTICO
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VIII. EVOLUCION
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IX. RECOMENDACIONES
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FIRMA DEL EVALUADOR:………………………………..