HISTORIA CLINICA PEDIATRICA

IDENTIFICACION

Fecha de elaboración: Fecha y lugar de nacimiento:

Nombres y Apellidos: Procedencia:
Edad: Dirección actual:
Sexo: Nombre de los padres:
Etnia: En caso de emergencia avisar a:

HOSPITALIZACIONES ANTERIORES:
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FUENTE DE LA HISTORIA Y CREDITO DEL INFORMANTE

CAUSA DE LA CONSULTA
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ENFERMEDAD ACTUAL
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ANTECEDENTES FAMILIARES
*Familiograma*
ANTECEDENTES PERSONALES

MATERNOS
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NATALES Y PERINATALES
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ALIMENTACION
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DESARROLLO PSICOMOTOR
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HABITOS Y CARACTERISTICAS DE LA PERSONALIDAD

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INMUNIZACIONES
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ANTECEDENTES PATOLOGICOS
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CARACTERISTICAS CULTURALES Y SOCIO-ECONOMICAS

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REVISION POR SISTEMAS

GENERAL
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PIEL
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CABEZA
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OJOS
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OIDOS
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NARIZ Y SENOS PARANASALES

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CAVIDAD ORAL
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CUELLO
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GANGLIOS LINFATICOS
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MAMAS
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RESPIRATORIO
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S. CARDIOVASCULAR
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S. GENITOURINARIO
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S. OSTEOMUSCULAR
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S. HEMATOPOYETICO
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S. ENDOCRINO
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S. NERVIOSO
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EXAMEN FISICO

APARIENCIA GENERAL
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CARACTERISTICAS DE LA PERSONALIDAD
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DESARROLLO
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PIEL
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GANGLIOS LINFATICOS
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CABEZA
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OJOS
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OIDOS
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NARIZ
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BOCA
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FARINGE
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NUCA Y CUELLO
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TORAX
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CARDIOVASCULAR
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PULMONES
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ABDOMEN
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GENITOURINARIO
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EXTREMIDADES
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COLUMNA VERTEBRAL
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SISTEMA NERVIOSO
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DIAGNOSTICO SEMIOLOGICO
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