Académique Documents
Professionnel Documents
Culture Documents
MSNH
Fecha de elaboracin:
Interrogatorio
1. Ficha de Identificacin
2. Antecedentes
a)
Heredo Familiares
Tuberculosis
Diabetes Mellitus
Hipertensin
Carcinomas
Cardiopatas
Hepatopatas
Nefropatas
Enf.endocrinas
Enf. Mentales
Epilepsia
Asma
Enf. Hematolgicas
Sfilis
Personales No patolgicos
Hbitos personales. bao ___________defecacin ___________ lav. dientes ___________ habitacin (ctos, piso, techo,
ven, hab, servicios) _____________________________________________________________________
Tabaquismo (cig/da/aos) _______________________
Trabajo/Desc
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Pasatiempos ___________
d)
Gineco obsttricos
3.
Padecimiento Actual
4. Sntomas Generales
1. Astenia
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2. Adinamia
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3. anorexia
4. fiebre
5. perdida de peso
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Aparato hematolgico. Datos
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Sistema nervioso. cefalea, sncope,
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Psicosomtico. Personalidad,
6. Diagnsticos anteriores
Exploracin Fsica
1. Signos Vitales
1. FC:
2. TA:
3. FR:
4. Temperatura
5. Peso actual:
6. Peso anterior:
7. Peso ideal:
2. Exploracin general
2. cuello
3. trax
4. abdomen
5. miembros
6. genitales
7. otros
4.
5.
Comentario
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Diagnostico
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Pronostico
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(especificar )
Tratamiento _______________________________________________________________________________
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