Documentos de Académico
Documentos de Profesional
Documentos de Cultura
IMSS
Servicio Ginecobstetricia
Diseo: Luis Humberto Cruz Contreras
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Ficha de identificacin
Nombre:
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Afiliacin:
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Edad:
Sexo:
________ aos
Femenino
Estado civil:
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Ocupacin:
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Origen:
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Reside:
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Religin
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Interrogatorio: ________________________________________________________________________
Responsable:
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Elaboracin:
Escolaridad:
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Transfusionales: _____________________________________________________________________________________________
Antecedentes Ginecoobsttricos
Menarca: ___________ Menstruacin : ____________________ IVSA: _________________ Mtodo Ant.___________
tiempo de uso ____________ FURN: ___/ ________/ _____ FPP ___/_______/_____ Gestas _____ Para ______ Cesreas
____________Abortos ________, No parejas sexuales: __________, Mtodo ant. que desea ______________, Menopausia
____________________ ltima Citologa vaginal ______________________, Autoexploracin mamara
______________________, Mamografa ______________________
Padecimiento Actual
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Sntomas Generales
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Exploracin Fsica
Signos Vitales
TA
Exploracin general
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Cabeza
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Cuello
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Trax
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Abdomen
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Extremidades
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Genitales
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Impresin Diagnstica:
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Mip _____________________________________