Roteiro de anamnese (adulto / idoso)

Nome:________________________________________ Idade: ____________

DN: ______________________ Escolaridade: _________________________
Mdico solicitante: _____________________________
Queixa principal:
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Histria da doena:
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Queixas cognitivas:
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Personalidade prvia: (como seu jeito de ser? Continua assim ou ocorreu alguma
mudana?)
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Alteraes comportamentais: (mudou de comportamento aps ser acometido pela
doena?)
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Escolaridade/Profisso: (qual o nvel de escolaridade e em que trabalha, como foi a

trajetria profissional)
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Vida social: (convive com quem, atividades fora de casa, participa de algum tipo de grupo
(igreja, clube, etc.))
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Dinmica familiar (com quem mora, irmos (idades e profisses), pais (idades e
profisso), arranjo familiar, familiar de referncia):
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Hbitos e rotina (o que gosta de fazer, preferncias, alimentao, sono):
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Antecedentes familiares (algum familiar tem alguma doena relacionada com a do
paciente?):
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Medicao:
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Outras condies mdicas: (perguntar se tem colesterol alto, presso ou algum outro tipo
de doena)
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Exames:
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Tratamentos:
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