Historia Clinica

I-FILIACION
NOMBRE Y APELLIDO:______________________________________
EDAD:____________________________________________________
DIRECCION:_______________________________________________
NIVEL DE OCUPACION:______________________________________
ESTADO CIVIL:_____________________________________________
NOMBRE RESPONSABLE:____________________________________
TELEFONO:________________________________________________
SEXO:_____________________________________________________
II-INTERROGATORIO
a. MOTIVO DE LA
CONSULTA:__________________________________________________
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b. EVOLUCION DE LA ENFERMEDAD
ACTUAL:_____________________________________________________
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c. ANTECEDENTES PERSONALES
PATOLOGICOS:_______________________________________________
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d. ANTECEDENTES PERSONALES NO
PATOLOGICOS:_______________________________________________
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e. ANTECEDENTES PERSONALES
FAMILIAR:____________________________________________________
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III- EXAMEN FISICO
SIGNOS VITALES
T

FR:

PA:

PULSO:

PESO:

TALLA:

FC:

a. INSPECION__________________________________________________
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b. PALPACION__________________________________________________
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c. PERCUSION__________________________________________________
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d. AUSCULTACION______________________________________________
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IV_DIAGNOSTICO__________________________________________________
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V_TRATAMIENTO__________________________________________________
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