FICHA KINESICA

NOMBRE:_____________________________________________________________________
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EDAD:_________ RUT:________________________
OCUPACIN:_________________________
PREVISIN:___________________________________________________________________
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NMERO CONTACTO:_____________ MDICO
TRATANTE:_____________________________
N SESIONES:

INICIO:

TERMINO:

DIAGNSTICO:_______________________________________________________________
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ANTECEDENTES MORBIDOS:
HTA ( ) Diabetes ( ) Fuma ( ) OH ( ) Insuficiencia cardiaca ( ) Asma ( )
Biotipo: ( ) Ectomorfo ( ) Mesomorfo ( ) Endomorfo
Estado: ( ) Crnico (> de 6 semanas) ( ) Estable (10 das a 6 semanas) ( )
Subagudo ( 5 a 10 das)
( ) Agudo (0 3 das) ( ) Inmediato (primeras horas)
Lesin Anterior
Medicamentos:

EVALUACIN:
OBSERVACIN INCIAL:
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ANAMNESIS
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INSPECCIN :

PALPACIN:
TEJIDO OSEO:
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TEJIDO MUSCULAR:
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LIGAMENTOS:
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RANGO ARTICULAR ACTIVO:

RANGO ACTICULAR PASIVO:

FUERZA MUSCULAR:

DIGNOSTICO TRIMODAL:

DEFICIENCIA (TRASTORNO):
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DISCAPACIDAD (LIMITACIONES):
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MINUSVALA:
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OBJETIVOS KINSICOS.

GENERAL:
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ESPECFICO A LARGO PLAZO: (MENCIONAR TIEMPO APROXIMADO)

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ESPECFICO A CORTO PLAZO: (MENCIONAR TIEMPO APROXIMADO)

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OPERACIONAL:
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EVOLUCIN:
NMER
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PROCEDIMIENTO

RESULTADO