Está en la página 1de 2

Nº_________

FICHA INGRESO PACIENTE

 
FECHA INGRESO___________________________________ FECHA

SALIDA_______________________________________ 

NOMBRE PROPIETARIO__________________________________________________________________________________

TELEFONOS____________________  PACIENTE__________________ESPECIE________________RAZA______________

SEXO  ___M ___H 

PESO__________ COLOR_____________________EDAD_____________ALIMENTO_______________ 

MEDICO

TRATANTE_____________________________________________________________________________________  

ANAMNESIS _____________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

ULTIMAS VACUNAS/DESPARASITACIONES_________________________________________________________________ 

________________________________________________________________________________________

________________________________________________________________________________________

SIGNOS CLINICOS

Tº__________DESHIDRATACIÓN___________MUCOSA_____________VOMITOS____ DIARREA_____GANGLIOS_______

FC________FR________

EXAMENES _____________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

DIAGNÓSTICO

__________________________________________________________________________________________ 
________________________________________________________________________________________

_________________________________

FIRMA

También podría gustarte