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ANAMNESE PEDITRICA

1. Identificao:

Nome:_________________________________________________________________________
Sexo___________________________________________________________________________
Idade:_________________________________________________________________________
Religio:_______________________________________________________________________
Cor:___________________________________________________________________________
Naturalidade:___________________________________________________________________
Informante:____________________________________________________________________
2. Motivo da consulta
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. Historia da doena
atual__________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

4. Antecedentes
4.1 Antecedentes familiares
4.1.1 Histria familiares
Pai __________________________________________
Profisso______________________________________
Sade ______________________________________

Idade ____________________

Me__________________________________________
Profisso______________________________________
Sade__________________ ______________________ idade_____________________

Numero de irmos vivos____,mortos,____sausa mortis__________________________


Posio da criana na famlia_______________________________________________
Condies habituais da criana

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