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REPÚBLICA BOLIVARIANA DE VENEZUELA

INSTITUTO VENEZOLANO DE LOS SEGUROS SOCIALES


HOSPITAL: “JOSÉ A. VARGAS”
PALO NEGRO – EDO. ARAGUA
SERVICIO DE PEDIATRÍA
ÓRDENES MÉDICAS

NOMBRE Y APELLIDOS: ________________________________________EDAD: ___________SEXO: ____

UBICACIÓN: _______________________________________ Nº HISTORIA: __________________________

FECHA Y HORA PESO: Kg. TALLA: cm. S. C.: m²

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