ficha atendimento individual

1 E-SUSAten o B sicaFICHA DE atendimento INDIVIDUALDIGITADO POR:DATA: CONFERIDO POR:FOLHA N :N DO CART O SUS DO PROFISSIONAL*CBO* - C d. CNES UNIDADE*C d. EQUIPE (INE)*DATA:* N DO CART O SUS DO PROFISSIONALCBO - N DO CART O SUS DO PROFISSIONALCBO - N 12345678910111213 TURNOMTNMTNMTNMTNMTNMTNMTNMTNMTNMTNMTNMT NMTNN PRONTU RION CART O SUSData de nascimento*Dia / m sAnoSexo*F MF MF MF MF MF MF MF MF MF MF MF MF MLocal de atendimento * (ver legenda)Tipo atendimento *Consulta Agendada Programada / Cuidado Continuado Consulta Agendada DemandaEspont neaEscuta Inicial / Orienta oConsulta no DiaAtendimento de Urg nciaAvalia oAntro-pom tricaPeso (kg)Altura (cm) Vacina o em dia? SIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OCrian aAleitamento Materno (ver legenda)GestanteDUMDia / M sAnoGravidez PlanejadaSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OIdade Gestacional ( Semanas )Gestas Pr vias / PartosAten oDomiciliarModalidade AD.

2 1, 2 ou 3 (ver legenda)AD___AD___AD___AD___AD___AD___AD ___AD___AD___AD___AD___AD___AD____Proble ma / Condi o Avaliada*AsmaDesnutri oDiabetesDPOCH ipertens o ArterialObesidadePr -natalPuericulturaPuerp rio (at 42 dias)Sa de Sexual e ReprodutivaTabagismoUsu rio de lcoolUsu rio de outras drogasSa de MentalReabilita oN 12345678910111213 Problema / Condi o Avaliada*Doen asTransmiss veisTuberculoseHansen aseDengueDSTR astrea-mentoC ncer do Colo do teroC ncer de MamaRisco cardiovascularOutrosCIAP2 - 01 CIAP2 - 02 CID10 - 01 Exames Solicitados(S) e Avaliados (A)Colesterol totalS AS AS AS AS AS AS AS AS AS AS AS AS ACreatininaS AS AS AS AS AS AS AS AS AS AS AS AS AEAS/EQUS AS AS AS AS AS AS AS AS AS AS AS AS AEletrocardiogramaS AS AS AS AS AS AS AS AS AS AS AS AS AEletroforese de HemoglobinaS AS AS AS AS AS AS AS AS AS AS AS AS AEspirometriaS AS AS AS AS AS AS AS AS AS AS AS AS AExame de escarroS AS AS AS AS AS AS AS AS AS AS AS AS AGlicemiaS AS AS AS AS AS AS AS AS AS AS

3 AS AS AHDLS AS AS AS AS AS AS AS AS AS AS AS AS AHemoglobina GlicadaS AS AS AS AS AS AS AS AS AS AS AS AS AHemogramaS AS AS AS AS AS AS AS AS AS AS AS AS ALDLS AS AS AS AS AS AS AS AS AS AS AS AS ARetinografia / Fundo de Olho com oftalmologistaS AS AS AS AS AS AS AS AS AS AS AS AS ASorologia de S filis (VDRL)S AS AS AS AS AS AS AS AS AS AS AS AS ASorologia para DengueS AS AS AS AS AS AS AS AS AS AS AS AS ASorologia para HIVS AS AS AS AS AS AS AS AS AS AS AS AS ATeste indireto de antiglobulina humana (tia)

4 S AS AS AS AS AS AS AS AS AS AS AS AS ATeste da orelhinhaS AS AS AS AS AS AS AS AS AS AS AS AS ATeste de GravidezS AS AS AS AS AS AS AS AS AS AS AS AS ATeste do olhinhoS AS AS AS AS AS AS AS AS AS AS AS AS ATeste do pezinhoS AS AS AS AS AS AS AS AS AS AS AS AS AUltrassonografia obst tricaS AS AS AS AS AS AS AS AS AS AS AS AS AUroculturaS AS AS AS AS AS AS AS AS AS AS AS AS AOutros(SIA)S AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS AS ASe usou alguma PIC, indicar qual (ver legenda)Ficou em Observa o?

5 SIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N OSIM N ONASF/PoloAvalia o / Diagn sticoProcedimentos Cl nicos / Terap uticoPrescri o Terap uticaConduta*Retorno para consulta agendadaRetorno p/ cuidado continuado/programadoAgendamento para GruposAgendamento p/ NASFAlta do epis dioEncaminhamentoEncaminhamento Interno no DiaEncaminhamento p/ Servi o EspecializadoEncaminhamento p/ CAPSE ncaminhamento p/ Interna o HospitalarEncaminhamento p/ Urg nciaEncaminhamento p/ Servi o de Aten o DomiciliarEncaminhamento Intersetorial Legenda: Op o M ltipla de Escolha Op o nica de Escolha (Marcar X na op o desejada)Local de atendimento : 01 - UBS 02 - Unidade M vel 03 - Rua 04 - Domic lio 05 - Escola/Creche 06 - Outros 07 - Polo (Academia da Sa de) 08 - Institui o / Abrigo 09 - Unidade prisional ou cong neres 10 - Unidade socioeducativa Aleitamento Materno: 01 - Exclusivo 02 - Predominante 03 - Complementado 04 - InexistenteModalidade de AD: Destinada a usu rios com dificuldade ou impossibilidade f sica de locomo o at uma unidade de sa de.

6 AD1: usu rios que necessitam de cuidados de menor intensidade, devendo ser acompanhados regularmente pela equipe de aten o b sica. AD2: usu rios que necessitam de cuidado intensivo, com visitas, no m nimo semanais. AD3: usu rio com os crit rios de AD2 somados ao uso de suporte ventilat rio n o invasivo, ou paracentese, ou di lise : 01 - Medicina Tradicional Chinesa 02 - Antroposofia aplicada sa de 03 - Homeopatia 04 - Fitoterapia 05 - Termalismo/Crenoterapia 06 - Pr ticas corporais e men-tais em PICs 07 - T cnicas manuais em PICs 08 - Outros * Campo Obrigat rioFAI/e-SUS AB