Académique Documents
Professionnel Documents
Culture Documents
Domicilio: ____________________________________________________________________
Antecedentes personales
No patológicos
Vivienda___________________________________________________________________________________________
Alimentación_______________________________________________________________________________________
Sueño ____________________________________________________________________________________________
Mascotas __________________________________________________________________________________________
Antecedentes patológicos
Enfermedades niñez
__________________________________________________________________________________________________
Enfermedades adulto
__________________________________________________________________________________________________
Antecedentes traumáticos
__________________________________________________________________________________________________
Hospitalizaciones
__________________________________________________________________________________________________
Antecedentes quirúrgicos
__________________________________________________________________________________________________
Hipersensibilidad
__________________________________________________________________________________________________
Antecedentes inmunológicos
__________________________________________________________________________________________________
Antecedentes familiares:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Antecedentes ginecoostetricos
Menarca___________________________________________________________________________________________
GESTAS____________PARTOS_______________CESARIAS_____________ABORTOS________
Menopausia _______________________________________________________________________________________
SNC
__________________________________________________________________________________________________
__________________________________________________________________________________________________
SCP
__________________________________________________________________________________________________
__________________________________________________________________________________________________
SGI
__________________________________________________________________________________________________
__________________________________________________________________________________________________
SGU
__________________________________________________________________________________________________
__________________________________________________________________________________________________
SME
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Signos vitales
P/A: _____________ FC: ____________ FR: _____________ TO: ______________ PULSO: ____________
Piel y faneras
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Cabeza
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Oídos
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Nariz
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Ojos
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Boca
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Cuello
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Tórax
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Mamas
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Corazón
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Pulmones
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Abdomen
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Genitales
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Extremidades
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Examen neurológico
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Diagnostico
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
____________________________________________________________
Conducta
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________