Paciente: ______________________________________________________________

Edad: ______________

Sexo: ___________________________

Medico: _______________________________________________________________
Da: ______________
Examen

Mes: ____________________
Resultado

Ao: __________________

Triglicridos

mg/dl

Valor Normal
Resultado
Hasta 150 mg/dl

Colesterol total

mg/dl

Hasta 200 mg/dl

Colesterol LDL

mg/dl

Hasta 130 mg/dl

Colesterol HDL

mg/dl

Glucosa

mg/dl

Hombres: mayor a 35
mg/dl
Mujeres: mayor a 45
mg/dl
60 110 mg/dl

Observaciones:_______________________________________________________________
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