Escolar Documentos
Profissional Documentos
Cultura Documentos
MOTIVO DE LA CONSULTA
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ANTECEDENTES
ANTECEDENTES PATOLÓGICOS PERSONALES: ______________________________________________________
ANTECEDENTES PATOLÓGICOS FAMILIARES: _______________________________________________________
ANTECEDENTES QUIRÚRGICOS: ____________________________________________________________________
HOSPITALIZACIONES: _______________________________________________________________________________
ENFERMEDAD ACTUAL
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SIGNOS VITALES Y ANTROPOMÉTRICOS:
PESO: _____ KG TALLA: _____ mts. IMC: _____/______________ TA: ____/_____mmHg
FC: ______ X´ FR: _____ X´ SatO2: ______ % T: _____ °C
EXAMEN FÍSICO
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DIAGNÓSTICO
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TRATAMIENTO
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MEDICACIÓN
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INDICACIONES
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PRÓXIMA CITA
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FIRMADO
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C.I.: ___________________ FIRMA
EVOLUCIÓN
HORA: FECHA:
NOTAS DE EVOLUCIÓN
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TRATAMIENTO
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MEDICACIÓN
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INDICACIONES
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PRÓXIMA CITA
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FIRMADO
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C.I.: ___________________ FIRMA
EVOLUCIÓN
HORA: FECHA:
NOTAS DE EVOLUCIÓN
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TRATAMIENTO
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MEDICACIÓN
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INDICACIONES
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PRÓXIMA CITA
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FIRMADO
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C.I.: ___________________ FIRMA
EVOLUCIÓN
HORA: FECHA:
NOTAS DE EVOLUCIÓN
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TRATAMIENTO
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MEDICACIÓN
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INDICACIONES
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PRÓXIMA CITA
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FIRMADO
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C.I.: ___________________ FIRMA
EVOLUCIÓN
HORA: FECHA:
NOTAS DE EVOLUCIÓN
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TRATAMIENTO
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MEDICACIÓN
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INDICACIONES
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PRÓXIMA CITA
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FIRMADO
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C.I.: ___________________ FIRMA