Atendimento Educacional Especializado

ANAMNESE
DATA: ____/____/_______
I - IDENTIFICAO
Nome da criana: ________________________________________________________________________
Data de Nasc: _____/_____/_________

Idade: ______________________

Nome da Me:___________________________________________________________________________
Nome do Pai: ___________________________________________________________________________
Responsvel pela criana:__________________________________________________________________
Telefones: ______________________________________________________________________________
Quem reside na casa? ( composio familiar)
Nome

Parentesco

Idade

II HISTRICO DA CRIANA
A criana est matriculada em alguma unidade bsica de sade?

Sim ( ) No ( )

Qual?_________________________________________________________________________________
Possui convnio mdico?

Sim ( )

No ( )

Qual? _________________________________________________________________________________
Freqenta alguma escola ou freqentou?

Sim ( )

No ( )

Qual? _________________________________________________________________________________
III ANTECEDENTES GESTACIONAIS E NEONATAIS
Havia doena preexistente da me antes da gravidez?

Sim ( )

No ( )

Qual?_________________________________________________________________________________
Fez pr-natal?

Sim( )

No( )

Durante a gravidez adquiriu alguma doena?

Sim ( )

No ( )

Qual?_________________________________________________________________________________
Fez tratamento?

Sim( )

Usou medicamento (s)?

No( )
Sim( )

No( )

Qual(is)?
_______________________________________________________________________________
Local onde a criana nasceu:_______________________________________________________________

PARTO

NASCEU A

AO NASCER

( ) normal

( ) termo

( ) chorou logo

( ) cesariana

( ) Pr-termo

( ) demorou pra chorar

( ) frceps

( ) Ps-termo

Apgar ______ / _______

Peso:_______________

Altura:________________

Houve problemas na hora do nascimento?

Sim ( )

Fototerapia? Sim( ) No ( )

No ( )

Qual(is)________________________________________________________________________________
Quando a me recebeu alta da maternidade, o RN tambm recebeu?

Sim ( )

No ( )

Porque no? ____________________________________________________________________________

O RN ao nascer ficou em:
( ) berrio

( ) enfermaria comum

) Nasceu em casa

( ) alojamento conjunto
( ) UTI peditrica
Realizou o teste do pezinho ? ____________________________________________________________
A criana possui alguma doena gentica, seqela de doena, trauma ou outra doena especfica?
( ) Sim

( ) No

( ) Em investigao

Qual (is)? ______________________________________________________________________________

Faz acompanhamento? ( ) Sim

( ) No

Onde? _________________________________________________________________________________
A me amamentou?

( ) Sim

( ) No

Durante quanto tempo? ___________________________________________________________________

IV DESENVOLVIMENTO
Sorriu aos ___________meses
Sustentou a cabea com ___________________________________________________________________
Sentou com ____________________________________________________________________________
Engatinhou com ________________________________________________________________________
Andou com ____________________________________________________________________________
Falou com _____________________________________________________________________________
Dentio aos ___________________________________________________________________________
Controla esfncteres?
Usa chupeta?
Enurese?

( ) Sim

( ) Sim

( ) No

( ) Sim

( ) No

Encoprese? ( ) Sim

( ) No

Usa mamadeira

( ) Sim

Alimenta-se sozinho
Veste-se sozinho ( ) Sim
( ) Agitado

( ) No

( ) Sim

Toma banho sozinho ( ) Sim

Sono:

( ) No

( ) No
( ) No

( ) No

( ) Tranqilo

V IMUNIZAO ( vacinao )

( ) Fala dormindo

( ) Sonambulismo

Completa ( )

Incompleta ( )

Vacinas especiais? ( ) Sim

( ) No

Qual (is)? ______________________________________________________________________________

VI DISTRBIOS
Viso ( ) _______________________________________________________________________
Audio (

) __________________________________________________________________________

Fala ( linguagem) (

) _________________________________________________________________

Motor ( ) ______________________________________________________________________________
Neurolgico ( ) _________________________________________________________________________
Psicolgico ( ) _________________________________________________________________________
Endocrinolgico (
Sindrmico (

) __________________________________________________________________

) ________________________________________________________________________

Aprendizagem (

) ____________________________________________________________________

Outros? _______________________________________________________________________
Quais? _______________________________________________________________________
Faz uso de medicamento(s) atualmente?
Qual(is)? _______________________________________________________________________
VII DOENAS PRPRIAS DA INFNCIA
( ) catapora
( ) pneumonia

( ) hepatite
( ) rinite

( ) rubola

( ) caxumba

( ) meningite

( ) encefalite

( ) outras

Quais ? ______________________________________________
VIII HISTRICO PREGRESSO DA CRIANA
Internaes?

( ) Sim

( ) No

Quantas? _____________________________________________

Porque?________________________________________________________________________________
Cirurgias?

( ) Sim

( ) No

Quais? _______________________________________________

______________________________________________________________________________________
Fraturas?

) Sim

) No

Onde e motivo?

________________________________________
Possui alergia a algum tipo de medicamento(s) ou substncia(s)

( ) Sim

( ) No

Qual (is) _______________________________________________________________________________

Usa

culos?

Sim

No

_________________________________________________________
Usa prtese auditiva? ( ) Sim

( ) No ___________________________________________________

IX HISTRICO ATUAL DA CRIANA

Faz acompanhamento mdico ou no mdico:

Neurolgico(

) _____________________________________________________________________

Oftalmolgico(

) _____________________________________________________________________

Ortopdico (

) _____________________________________________________________________

Psiquitrico(

) _____________________________________________________________________

Otorrinolaringolgico(
Psicolgico (
Odontolgico(

) ________________________________________________________________

) _____________________________________________________________________
) _____________________________________________________________________

Fonoaudiolgico(

) _____________________________________________________________________

Fisioterpico(

) _____________________________________________________________________

Pedaggico (

) _____________________________________________________________________

Outros: _____________________________________________________________________
X OBSERVAES E CONDUTAS
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Professor Sala multifuncional

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