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DR.

EDGAR ISAAC DE LA CRUZ CRUZ


MÉDICO CIRUJANO PARTERO
CEDULA PROFESIONAL 12864070

PACIENTE: _______________________________________________________________ FECHA: _______________________

Edad: __________
1. ____________________________________________________________________
Peso: ___________
Talla: ___________ ____________________________________________________________________
2. ____________________________________________________________________
SIGNOS
F.C.: ___________ ____________________________________________________________________
F.R.: ____________ 3. ____________________________________________________________________
T°: _____________
T.A.: ____________ ____________________________________________________________________
Gluc.: __________ 4. ____________________________________________________________________
SPo2%: _________
Alergias: _______ ____________________________________________________________________
________________ 5. ____________________________________________________________________

Idx: ____________ ____________________________________________________________________

FARMACIA DE LA CRUZ
________________ 6. ____________________________________________________________________
____________________________________________________________________

La Concepción de los WHATSAPP ÚNICAMENTE


Baños, Ixtlahuaca. 5644353962
NO DOY CONSULTAS Firma: _______________________________
POR WHATSAPP

DR. EDGAR ISAAC DE LA CRUZ CRUZ


MÉDICO CIRUJANO PARTERO
CEDULA PROFESIONAL 12864070

PACIENTE: _______________________________________________________________ FECHA: _______________________

Edad: __________
Peso: ___________ 1. ____________________________________________________________________
Talla: ___________ ____________________________________________________________________
SIGNOS 2. ____________________________________________________________________
F.C.: ___________ ____________________________________________________________________
F.R.: ____________
T°: _____________ 3. ____________________________________________________________________
T.A.: ____________ ____________________________________________________________________
Gluc.: __________
SPo2%: _________ 4. ____________________________________________________________________
Alergias: _______ ____________________________________________________________________
________________
5. ____________________________________________________________________
Idx: ____________ ____________________________________________________________________
________________

FARMACIA DE LA CRUZ
6. ____________________________________________________________________
____________________________________________________________________

La Concepción de los WHATSAPP ÚNICAMENTE:


Baños, Ixtlahuaca. 5644353962
NO DOY CONSULTA POR Firma: _______________________________
WHATSAPP

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