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Trate 3 pessoas (parentes ou amigos) por 3 semanas, preencha todos os dados na ficha
abaixo e descreva os resultados.
EX: Torcicolo, dor na coluna, sinusite, crise de asma, etc e você utilizou algumas
sessões de auriculoterapia e o paciente apresentou melhora.
Para isso, tire 03 xerox das páginas seguintes, as quais nos serão enviadas
junto com o Termo de Livre Consentimento dos pacientes tratados .
Exemplo: 1ª. Sessão: Técnicas e pontos utilizados: Agulhas filiformes nos pontos Shen
Men, Simpático e Rim; Agulhas Semipermanentes de 1.8 mm nos pontos Shen Men,
Simpático, Rim e Ombro.
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ESPAÇO SO-HAM
DE TERAPIA HOLÍSTICA
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FICHA DE ANAMNESE OCIDENTAL
Terapeuta:____________________________________________ REG:_____________
Data:_____/____/___ Local:______________________________
NOME:________________________________________________________________
ENDEREÇO:___________________________________________________________
______________________________________________________________________
DATA NASC:_______/_________/_____________IDADE:_____________________
SEXO:_____________________________ESTADO CIVIL:_____________________
NACIONALIDADE:____________________NATURALIDADE:_________________
PROFISSÃO:_____________________________FONE RES:____________________
ALTURA:____________________PESO:___________________IMC:_____________
PA:______________________FC:___________________FR:____________________
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1). QUEIXA PRINCIPAL:
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5). MEDICAMENTOS UTILIZADOS:
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6). QUALIDADE DO SONO: (Horário, tempo médio de sono por noite,, perturbações
do sono).
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7). ALIMENTAÇÃO:
b).Horários:_______________________________________________________
______________________________________________________________________
c). Preferências:___________________________________________________
d). Bebidas:____________Tipo:______________Quantidade:______________
8). TABAGISMO:__________QUANTIDADE:___________TEMPO:_____________
9).ETILISMO:_________________________TIPO:____________________________
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QUANTIDADE_________________FREQUÊNCIA______________TEMPO:______
______________________________________________________________________
a). Pai:_______________________
b). Mãe:______________________
c).Irmãos:_____________________
d). Cônjuge:___________________
e). Filhos:_____________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
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DATA EXAMES LAUDO
DIAGNÓSTICOS
CLÍNICOS
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AVALIAÇÃO DO CASO:
IDENTIDADE(RG)________________________
________________________________________________________________
ASSINATURA DO CLIENTE
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FICHA DE AVALIAÇÃO AURICULAR
TERAPEUTA:_______________________________________DATA:_____________
PACIENTE:_________________________________________IDADE:____________
pavilhão auricular:
- Coloração - Pápulas
- Proeminências - Proeminências
- Depressões - Descamações
- Porosidades - Angiectasias
- Teleangiectasias - Irregularidades
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ORELHA DIREITA
FOSSA TRIANGULAR:
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CONCHA CIMBA:
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CONCHA CAVA;
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ANTI-HÉLICE:
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ESCAFA:
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RAIZ DA HÉLICE:
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HÉLICE:
______________________________________________________________________
______________________________________________________________________
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______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
TRAGO:
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INCISURA INTERTRAICA:
______________________________________________________________________
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ANTITRÁGO:
______________________________________________________________________
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______________________________________________________________________
LÓBULO:
______________________________________________________________________
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CONCLUSÕES:
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ORELHA ESQUERDA:
FOSSA TRIANGULAR:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
CONCHA CIMBA:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
CONCHA CAVA;
______________________________________________________________________
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______________________________________________________________________
______________________________________________________________________
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ANTI-HÉLICE:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
ESCAFA:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
RAIZ DA HÉLICE:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
HÉLICE:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
TRAGO:
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INCISURA INTERTRAICA:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
ANTITRÁGO:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
LÓBULO:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
CONCLUSÕES:
______________________________________________________________________
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______________________________________________________________________
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FICHA DE AUTO AVALIAÇÃO DO CURSO:
NOME:________________________________________________________________
E MAIL: ______________________________________________________________
AURICULOTERAPIA?
______________________________________________________________________
2). O QUE VOCÊ MAIS GOSTOU E O QUE MENOS GOSTOU NESTE CURSO?
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MELHORANDO O CURSO?
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FUTURAMENTE?
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______________________________________________________________________
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DÚVIDAS E OBSERVAÇÕES
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