HABITACION: _____________ CAMA________
OCUPACION: __________________________________
ORIUNDO_____________________________________
NOMBRE _____________________________________
CC:__________________________ EDAD: __________
MC___________________________________________
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EA:___________________________________________
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ANTECEDENTES:
PATOLOGICOS:_________________________________
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HEREDOFAMILIARES:____________________________
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QUIRURGICOS__________________________________
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ALERGICOS____________________________________
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FARMACOLOGICOS______________________________
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TOXICOS______________________________________
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EXAMEN FISICO
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REVISION POR SISTEMA__________________________
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ANALISIS______________________________________
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PLAN_________________________________________
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DIAGNOSTICO__________________________________
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CAMBIOS______________________________________
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EXAMENES AL INGRESO__________________________
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TRATAMIENTO ACTUAL
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EVOLUCION PENDIENTES___________________________________
HABITACION _____________ CAMA __________ ______________________________________________
CC._____________________________ ______________________________________________
FECHA DE INGRESO _____________________________ ______________________________________________
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INTRODUCCION ______________________________________________
NOMBRE _____________________________________
EDAD_____ ORIUNDO DE ________________________ FECHA: FECHA:
OCUPACION___________________________________ LEUC GOT
PACIENTE CON _________________ DIAS DE ESTANCIA LINF GPT
HOSPITALARIA CON DIAGNOSTICO DE:
NEUT FA
1.____________________________________________
2.____________________________________________ MON BILR
3.____________________________________________ EOSIN DIR
4.____________________________________________ BASOF INDIR
5.____________________________________________ HB NA+
VMC K+
Subjetivo: (impresiones expresadas por el paciente, HCM CL-
revisión por sistema):
PLAT OSM
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______________________________________________ INR GAP
______________________________________________ PT VIH
PTT BK
Objetivo: FC____ FR____ TA__________________ CR pH
SAT______ GLUCOMETRIA ___________________ BUN PO2
PESO_______ TALLA:__________ IMC_________
UREA PCO2
Análisis: __________________________________
DEPC-G HCO3
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_________________________________________ GLICE D(A-a)
_________________________________________ HDL SO2
_________________________________________ LDL LACTA
RXTORAX__________________________________ COLES P. TOL
__________________________________________ TRIG P. DIF
__________________________________________ CA++ ALBU
EKG______________________________________ PO4-3 AMILA
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VDRL LIPASA
PARCIAL DE ORINA__________________________
FTABS L. PLE
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_________________________________________ LDH pH
OTRO PARACLINICO SI___ NO___ VSG GLUC
CUAL: ____________________________________ PCR PROTE
REPORTE:__________________________________ RETIC LDH
__________________________________________ FERRIT LEUCO
__________________________________________ TRASF ADA
__________________________________________ STRASF AMILA
__________________________________________ FE++ COLES
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TORCH
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