Está en la página 1de 1

T5 VVVVVV 1+

HISTORIA CLÍNICA
DATOS DEL PACIENTE:

NOMBRES Y APELLIDOS:_________________________________________________________

EDAD:________________________________________________________________________

DNI:_________________________________

FECHA DE NACIMIENTO:_________________________________________________________

SIGNOS VITALES:

T°:_____________ PA:_______________ MMHG:________ FR:___________ SO2:_________

PESO:_______________________ TALLA:____________________________

APP:_________________________________________________________________________

ARP:_________________________________________________________________________
HGO: G:_______________ P: ____________________ A:_________________________

ANAMESIS:____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

EXAMEN FISICO:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

DIAGNOSTICO:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

INDICACIONES
MEDICAS:_____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

FECHA: _________/___________/_______

También podría gustarte