Anamnese de Disfonia Infantil
Anamnese de Disfonia Infantil
Anamnese de Disfonia Infantil
Identificação
Nome: _____________________________________________________________________________
Data de nascimento:____/__/__ Idade: _________________
Naturalidade: ___________________________
Nacionalidade: ___________________________
Sexo:Masc ( ) Fem ( )
Endereço: __________________________________________________________________________
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Telefone: __________________________________________
Filiação:
Pai: ___________________________________________________
Grau de Instrução:_____________________________________________
Profissão: _____________________________________________
Mãe: _____________________________________________
Grau de Instrução:_____________________________________________
Profissão: _____________________________________________
Informante: _____________________________________________
Desenvolvimento Neuropsicomotor
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Desenvolvimento Escolar
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- Descrever
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- Outros dados?
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• Abusos Vocais
• Competição Vocal
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Saúde
- Estado Geral
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- Tratamentos realizados_____________________________________________________
Dados da criança
( ) curiosa
( ) sensível ( ) alegre ( explosiva ( ) sensível ( ) alegre
( ) preguiçosa ( ) você lenta ( ) outros ___________________________________________________ ( )
alegre ( )
- Rotina diária
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Antecedentes familiares
- Alergias _________________________________________________________
Tratamentos anteriores
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Laudo do Otorrinolaringologista
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• Outros exames
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Conclusão:
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