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TERAPIA OCUPACIONAL

Anamnese

1. Identificao

nome:__________________________________________________________

srie:
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endereo:
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data de nascimento:______/______/_______

idade:__________________________________________________________

sexo:____________________

religio:________________________________________________________

pai:____________________________________________________________

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escolaridade:____________________________________________________

idade:__________________________________________________________

ocupao:_______________________________________________________

me:___________________________________________________________

escolaridade:___________________________________________________
idade:___________

ocupao:______________________________________________________

informante:______________________________________________________

2. queixa principal e encaminhamento

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idade em que foi percebido problema:_________________________________

providncias tomadas na ocasio:___________________________________

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3. Histria Pregressa

a. gestao foi planejada?__________________________________________

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b. Houve gestaes interrompidas e/ou natimortos


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4. Gestao

a. Como a me reagiu noticia da gravidez?

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b. Pr-natal? Nmero de consultas? Quando iniciou? Uso de medicamentos?

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c. Intercorrncias, doenas ou acidentes domsticos durante a gestao?


Quais?

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d. Houve ameaa de aborto?

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e. Realizou cirurgia, transfuso de sangue ou algum tratamento especial
durante a gestao?

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5. Parto

a. a termo____________________________ (semanas)_________________

b. hospital ( ) casa ( ) com mdico ( ) parteira ( )

c. o parto foi normal ( ) frceps ( ) cesariana( )

por qu?________________________________________________________

d. tipo de anestesia: geral ( ) raquidiana ( ) peridural ( ) nenhuma ( )

e. descrio do parto: _____________________________________________

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f. posio do beb: cabea ( ) face ( ) mos ( ) ps ( ) ndegas ( ) outra ( )

g. houve algum problema com o beb logo que nasceu? __________________

h. nasceu ciantico?_______________________________________________

i. chorou logo?___________________________________________________

j. qual o peso e tamanho?_________________________________________


l. teve ictercia?_______ como foi tratado?____________________________

m. APGAR: 1 __________________ 5_______________________________

6. Desenvolvimento

a) alimentao:

1. como foi o aleitamento desde o nascimento at o desmame? e as reaes


introduo de outros tipos de alimentao?

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2. teve ou tem problema para mastigar e/ou engolir?

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3. hbitos alimentares da criana (quantas refeies por dia, o que come, o que
prefere, come muito, come pouco, foi ou forado a comer)

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b) desenvolvimento psicomotor:

1. idade em que sustentou a cabea?_________________________________

2. quando sentou sozinha?__________________________________________

3. engatinhou?______________quando?
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4. quando andou?____________anda adequadamente?__________________

5. quando controlou os esfncteres?__________________________________

anal: diurno_____________________________
noturno________________________________

vesical: diurno__________________________
noturno________________________________

6. onde ficava a criana qdo bebe


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7. caia muito quando pequena?


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8. era desajeitada ou estabanada a ponto de chamar ateno?

c) linguagem:

1. em que idade se deu o balbucio?__________________________________

2. quando falou as primeiras palavras?________________________________

e as primeiras frases?_____________________________________________

3. apresenta algum problema de linguagem ou de comunicao?


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4. apresenta gagueira?____________________________________________

5. tem boa compreenso do que falam?_______________________________

6. como a criana foi estimulada a falar?


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7. quem conversa mais com a criana?


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8. H hbitos de contar historias?


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9. Tem acesso a livrinhos?


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10. Quando a criana fala errado, qual a reao dos pais?

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d) sono:

1. como o sono? calmo ( ) sudorese quando dorme ( ) sonambulismo( )

agitado ( ) fala dormindo ( ) range os dentes ( ) baba quando dorme( )

2. a que horas costuma dormir a noite?_______________________________

3. apresenta problemas quando deve ir dormir?_________________________

4. dorme durante o dia?____________________________________________

5. tem algum hbito diferente antes de dormir?

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6. dorme em quarto s seu? divide com quem?_________________________

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7. dorme em cama separada?_____________________________________

e) sade

1. consulta o mdico regularmente ou somente quando necessrio?

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2. Doenas:

a criana teve convulses?__________________________________________

desmaios?______________________________________________________

sarampo ( ) idade:______________________

coqueluche ( ) idade:____________________

febre alta ( ) idade:______________________

vermes ( ) idade:______________________

varicela ( ) idade:______________________

asma ( ) idade:______________________

caxumba: ( ) idade:______________________

traumatismo ( ) idade:______________________

alergia ( ) idade:______________________

bronquite ( ) idade:______________________

4. Cirurgias (do qu? idade?):_______________________________________

6. hospitalizao (motivo, idade e durao):____________________________

7. tratamentos e medicamento em uso:_______________________________

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8. viso/audio

Percebe alguma dificuldade visual ou auditiva que sobressaia? ___________


9) manipulao e hbitos:

1. usou chupeta? ___________________________at quando? __________

ainda usa?_____________________________________________________

2. chupou o dedo? ___________________ at quando? ________________


ainda faz? ______________

3. roeu unhas?____________________ at quando? ________________


ainda faz? ________________

4. puxa a orelha?
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5. puxa os cabelos?
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6. morde os lbios?
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10) sociabilidade

1. o que faz quando no est na escola?

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2. prefere brincar sozinha ou acompanhada?


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3. retrado ou extrovertido?
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5.briga facilmente?
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6. como reage s brincadeiras feitas com ela?


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7. prefere crianas mais novos ou mais velhos?


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8. que tipo de brincadeiras prefere?

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9. demonstra cime em relao a algum?

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10. fala sozinha?


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11. brinca de faz de conta?

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12. imita animais? Pessoas e situaes cotidianas_______________________

13. quando tem algum problema como reage?


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14. O que a criana evita e que te chama a ateno?

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15) vesturio e higiene / organizao

a. despe-se/veste-se sozinha?
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b. toma banho, lava as mos, penteia-se sozinha?

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c. tira/cala meias e sapatos adequadamente?

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d. faz n e lao?

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e. como organiza seus brinquedos?


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f. ajuda em alguma tarefa em casa?


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g. ajuda a arrumar os materiais escolares?


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h. como fica o banheiro depois do banho?_________________________

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16. H antecedentes familiares para algum transtorno, distrbio ou deficincia?

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17. Relacionamento familiar

a. existem conflitos exacerbados entre o casal?


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b. a criana mais protegida por quem?

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c. como a relao entre a me e a criana?

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d. como o relacionamento entre o pai e a criana?

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e. Como o relacionamento entre irmos?

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f. os pais realizam alguma atividade juntamente com a criana (brincar, criar,


trabalhar, assistir tv, etc.)?

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g. Quando tenta realizar uma tarefa com certo grau de dificuldade tende a
evita-la? desviando a ateno para seus prprios pensamentos? ( na hora da
lio quer tomar lanche)

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18. Escola

a. reclama de ir para a escola?


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b. Quando iniciou a escolaridade? Houve mudana de escola?

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c. H queixas da escola em relao criana?

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d. Ela gosta da professora? Da escola? Das atividades?


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e. Quem ajuda nas tarefas de casa?

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f. o que a famlia faz quando a criana no vai bem na escola?

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g. qual a maior dificuldade escolar apresentada pela criana em sua
percepo?

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h. como a criana se comporta na sala?

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i. Como a que a famlia avalia a escola?

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j. Como a que a famlia avalia da professora?

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19. Como voc avalia sua criana em relao a outras da mesma idade?

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20. Sua criana age como se no ouvisse e/ou demora a entender as coisas?
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21. Seu filho(a) conta como foi o dia na escola? O que ela relata?
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22. Seu filho j foi avaliado por outros profissionais da rea de sade?
Quando? Qual o resultado?

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data _____________/______________/______________

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