FICHA ANAMNESE

FACID

1. IDENTIFICAO
NOME:_________________________________________________________________________________________
SEXO:_______________________________IDADE:__________ COR: branca/parda/preta-_____________________
ESTADO CIVIL:__________________________ PROFISSO:_____________________________________________
NATURAL DE:____________________________ PROCEDENTE_________________________________________
2. QUEIXA PRINCIPAL
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3. HISTRIA DA DOENA ATUAL (HDA)
(durao total, incio, curso, caractersticas,sintomas associados, efeitos de tratamentos,progresso, repercusses
sobre a vida do paciente,ordem cronolgica, sintomas associados)
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4. INTERROGATRIO SINTOMATOLGICO
Sintomas gerais: alteraes do peso (em quanto tempo),febre, calafrios, astenia, sudorese noturna , anorexia
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Pele e fneros: prurido, leses cutneas (localizao),alopecia, alteraes da pigmentao, anormalidades nos plos
e na aparncia ungueal.
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Cabea e pescoo: cefalia, cervicalgia, limitao da movimentao do pescoo, tumoraes cervicais
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Olhos: dor ocular, acuidade visual, diplopia, fotofobia,lacrimejamento, secreo conjuntival, escotomas visuais,
viso turva, correo com culos ou lentes de contato
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Ouvidos, nariz e seios da face: otalgia, algias faciais,congesto periorbitria, epistaxe, otorria, rinorria,
obstruo nasal, espirros freqentes, gota ps-nasal,zumbidos, acuidade auditiva, vertigem
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Cavidade Oral: odontalgia, gengivorragias, ulceraes damucosa, queimao ou ardncia da lngua, odinofagia,
sialose, dor em ATM
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Mamas: mastalgia, descarga mamilar, ndulos palpveis.Ginecomastia no homem.
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Respiratrio: tosse, expectorao (aspecto e quantidade),rouquido, hemoptise, dor torcica, dispnia, chiado no trax
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Cardiovascular: precordialgia, palpitaes, dispnia de esforo, noturna e de decbito, sncope, edema, cianose,
claudicao intermitente, veias varicosas, lceras de perna
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Gastrintestinal: disfagia, pirose, intolerncia alimentar,eructaes, empachamento, regurgitao, epigastralgia,
clicas, ictercia, nuseas e vmitos, hematmese, hbito intestinal (n0 de evacuaes dirias, aspecto das fezes - cor
e consistncia -, presena elementos anormais - sangue, muco e/ou pus), tenesmo evacuatrio, dor e prurido retal,
enterorragia, melena, meteorismo, clicas, flatulncia, obstipao intestinal
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Urinrio: dor (lombar, no flanco, vesical), disria, alteraes miccionais, estrangria, polaciria, alteraes da cor e odor
da urina, nictria, enurese, oligria, poliria, incontinncia urinria de esforo (mulher), gotejamento terminal e fora do
jato urinrio (homem), eliminao de clculos durante a mico
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Genital: homem (corrimento uretral, leses genitais,disfunes sexuais); mulher (leucorria, prurido
vulvovaginal, sangramento intermenstrual, dor plvica,dispareunia)
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Osteoarticular: artralgias, rigidez matinal, edema articular,limitao de movimentos, deformidades, lombalgia
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Hematopoitico: palidez, tendncias hemorrgicas,linfadenomegalias, esplenomegalia, hepatomegalia
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Endcrino: intolerncia ao frio ou ao calor, poliria, polifagia e polidipsia, hirsutismo
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Nervoso: paresias (paralisia moderada), paralisias,parestesias, atrofias musculares, tremores, convulses,
ausncias, perturbaes da memria (amnsia transitria ou permanente)
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Psiquismo: insnia, nervosismo, choro freqente,irritabilidade, tristeza, sentimento de culpa, perda de interesse
e prazer no trabalho e no lazer
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5. ANTECEDENTES PESSOAIS FISIOLGICOS
Condies de gestao e nascimento
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Desenvolvimento neuropsicomotor:
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Imunizaes (BCG, DTP, anti-polio, hepatite viral, antitetanica,gripe )
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Adolescncia: (puberdade, surgimentos dos caracteres secundrios)
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Atividade sexual e vida reprodutiva (primeiro contato,parceiros, freqncia de relaes, camisinha,
menstruao(fluxo, ciclo), gestaes, partos)
Climatrio: (idade da menopausa, ondas de calor,ressecamento vaginal)
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6. ANTECEDENTES PESSOAIS PATOLGICOS

Doenas da infncia (sarampo, catapora, rubola, caxumba)
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Doenas apresentadas na vida adulta ( tuberculose, DST,hepatite, diabetes, hieprtenso arterial, cardiopatias,
epilepsias, febre reumtica, asma, aborto espontneo ou no,disfuno sexual) :
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Antecedentes de alergia:
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Hospitalizaes:__________________________________________________________________________________
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Traumatismos:___________________________________________________________________________________
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Hemotransfuses:________________________________________________________________________________
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Uso de drogas injetveis
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Medicaes de uso prolongado
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7. ANTECEDENTES FAMILIARES
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8. ANTECEDENTES SOCIAIS
Condies de habitao e higiene:
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Condies de alimentao:
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Nvel de instruo: ________________________________________________________________________________
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Histria Ocupacional:
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Religio: _______________________________________________________________________________________
Renda familiar mensal:
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Hbitos e costumes: tabagismo (durao, tipo de cigarro, nde cigarros consumidos por dia), consumo de lcool
(durao, tipo de bebida, quantidade consumida), banhos de rios audes e lagoas (localidade e poca), contato com o
triatomneo, contato com animais domsticos, prtica regular de exerccios fsicos (tipo e freqncia), sono, lazer,
viagens,uso de drogas ilcitas
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