Ficha Traumatolgica

Datos Personales:
Nombre:
F. de Nac:

Edad:

Profesin:

Rut:
Empresa:

Antecedentes mrbidos:
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F. del Accidente:
Descripcin del accidente o lesin:
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Tratamiento mdico:
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Dnde le duele?
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E.V.A
0 1

10

Con que disminuye el dolor?

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En que lo limita (que le impide hacer)?

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Segmento afectado: ___________________Lateralidad:__________________________

Inspeccin:
Observacin:
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Piel:
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Volumen:
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Screening:
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Funcionalidad:
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Palpacin:
Dolor:
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Trofismo:
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Sensibilidad:
Cutnea:
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Propioceptiva:
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Cortical:
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Movilidad Pasiva:
Osteokinematica:
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Artrokinematica:
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Evaluaciones:
Goniometra:
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Muscular:
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Pruebas ortopdicas:
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Pruebas funcionales:
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Barthel:
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Dg. Kinsico:
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Objetivo general:
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Objetivos especficos:
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