HISTORIA CLINICA

DATOS DE FILIACION

NOMBRES Y APELLIDO_______________________________________________________________

DIRECCION_________________________________________TELEFONO CELULAR_______________

FECHA DE NACIMIENTO__________________________EDAD______________SEXO______________

PROCEDENCIA______________. ESTADO CIVIL______________ OCUPACION___________________

CEDULA DE IDENTIDAD__________________________RECIDENCIA_________________________

FECHA DE CONSULTA___________________GRADO DE INSTRUCCIÓN_________________________

FUENTE DE INFORMACION______________________________________________

MOTIVO DE CONSULTA

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ENFERMEDAD ACTUAL

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ANTECEDENTES PERSONALES NO PATOLOGICOS

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ANTECEDENTES PERSONALES PATOLOGICOS

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ANTECEDENTES FAMILIARES

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EXAMEN FISICO

TA:._____________ FC:_____________ FR:_______________ T:_________

PESO:______________ TALLA:__________________

IMPRESIÓN GENERAL
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CONSTITUCION:
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FACIES:
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ACTITUD:___________________________________________________________________
DECUBITO:
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MARCHA:
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CABEZA:

Cráneo y cara:_______________________________________________________________
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CUELLO:
Inspeccion: _________________________________________________________________
Palpacion: _________________________________________________________________
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Percusion: __________________________________________________________________

Auscultacion: _____________________________________________________________________
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RESPIRATORIO:

Inspeccion: _______________________________________________________________________
Palpacion: ________________________________________________________________________
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Percusion: __________________________________________________________________
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Auscultacion: _____________________________________________________________________
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CARDIOVASCULAR:

Inspeccion:________________________________________________________________________
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Palpacion: ________________________________________________________________________-
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Percusion: _______________________________________________________________________
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Auscultacion: _____________________________________________________________________
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ABDOMEN:

Inspeccion: _______________________________________________________________________
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Palpacion: ________________________________________________________________________
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DIAGNOSTICO:

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TRATAMIENTO
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