Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Antecedentes heredofamiliares
Abuelos paternos (edad, vivos o muertos-causa de la muerte, sanos o enfermos- causa y si están
en tratamiento y/o control médico-fecha de diagnóstico):
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Abuelos maternos (edad, vivos o muertos-causa de la muerte, sanos o enfermos- causa y si están
en tratamiento y/o control médico-fecha de diagnóstico):
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Hermanos (edad, vivos o muertos-causa de la muerte, sanos o enfermos- causa y si están en
tratamiento y/o control médico-fecha de diagnóstico):
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Pareja o cónyuge (edad, vivos o muertos-causa de la muerte, sanos o enfermos- causa y si están
en tratamiento y/o control médico-fecha de diagnóstico):
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Abuelos paternos (edad, vivos o muertos-causa de la muerte, sanos o enfermos- causa y si están
en tratamiento y/o control médico-fecha de diagnóstico):
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Otros familiares directos (edad, vivos o muertos-causa de la muerte, sanos o enfermos- causa y si
están en tratamiento y/o control médico-fecha de diagnóstico):
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Enfermedades hereditarias:
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Antecedentes personales no patológicos
Hábitos higiénicos
Baño: ___________________________________________________________________________
Tóxicos
Drogadicción: __________________________
Infectocontagiosos:
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- Sistema cardiovascular (cianosis, palpitaciones, dolor precordial, dolor torácico, disnea durante o
después del ejercicio, ortopnea, desmayos, soplos cardiacos, varices, edema en extremidades,
hipertensión, hipotensión, otros):
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- Sistema digestivo (halitosis, nauseas, vomito, pirosis, disfagia, odinofagia, distención abdominal,
diarrea, estreñimiento, parasitosis, hemorroides, prurito rectal, alteraciones del apetito, ictericia,
flatulencia, cólico, sangre en excremento, otros):
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- Sistema urinario (cambios en la orina, litiasis, dolor renal y vesical, disuria, poliuria, coliuria,
oliguria, hematuria, retención de orina, nicturia, otros):
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- sistema genital (masculino: prostatitis, secreción peneana, prurito, lesiones en piel, hematuria,
escurrimiento uretral, antecedentes de enfermedades venéreas. Femenino: prurito, flujo vaginal,
infertilidad, secreción de calostro, mastalgia, cambio de coloración en mamas, otros):
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- Sistema locomotor (distrofias y atrofias musculares, artritis, artralgias, mialgias, dolor de las
articulaciones o de extremidades, cuello espalda, otros):
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- Sistema nervioso (mareos, parestesias, convulsiones, cefalea, debilidad muscular, alteraciones
de memoria, delirio, ilusiones, dislalia, dislexia, vértigos, temblores, parestesias, perdida de
sensibilidad, sincopes, alteración del habla, otros):
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Signos vitales
Diagnostico:
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Pronostico:
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Tratamiento:
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Interconsulta (motivo):
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Exámenes de gabinete:
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Higiene oral
Odontograma
Notas de evolución
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