República Bolivariana de Venezuela

Misión Medica Cubana

Misión Barrio Adentro

Consultorio Médico Popular 5 DE JULIO

HISTORIA CLINICA INDIVIDUAL

NOMBRES Y APELLIDOS:_______________________________________ FN:_________________

EDAD:_______CI:N____________________N°DE TELEFONO:__________________________

DIRECCION:_________________________________________________________________

APP:_______________________________________________________________________

APF:__________________________________________________________________________

INTERVENCION QUIRURGICAS: _____________________________________________________

VACUNAS:___________________________________________________________________

HEA:____________________________________________________________________________
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EXAMEN FISICO

PIEL Y MUCOSA: _________________________________________________________________

AP.RESPIRATORIO:_________________________________________________________________

AP.CARDIOVASCULAR:______________________________________________________________
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ABDOMEN:_______________________________________________________________________
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RHS:_____________________________________

TCS:_____________________________________

SNC:____________________________________________________________________________

IDX:_____________________________________________________________________________

CAS:____________________________________________________________________________