FICHA ATENCIONES MÉDICAS A COLABORADORES DEL CÍRCULO DEPORTIVO

INTERNACIONAL SAN SALVADOR Y EL BALSAMAR

Nombre: _______________________________________________________

Edad: ______________ Sexo: ___________________ Área: _____________________________

Consulta por: _____________________________________________________

Historia Clínica

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Antecedentes médicos:

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Examen físico:

Presión arterial: _______________________ Glucosa al azar: _____________________

Frecuencia cardíaca: ____________________ Frecuencia respiratoria: ________________

Diagnóstico : _________________________________

Tratamiento y Recomendaciones:

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