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• Abner I. Guzman Felix

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UNIVERSIDAD DE QUINTANA ROO/ DIVISIÓN DE CIENCIAS DE LA SALUD CICLOS CLINICOS OTOÑO 2018/ SEDE ISSSTE CHETUMAL

NOMBRE DEL ESTUDIANTE: ___________________________________________________________________________ GRADO: ____________________________ HISTORIA CLÍNICA No: _____________________

HISTORIA CLÍNICA FECHA: _____________________________ HORA: __________________________________ FICHA DE IDENTIFICACIÓN: NOMBRE: ______________________________________________________________________ EDAD: ______________ FECHA DE NACIMIENTO: __________________________________________SEXO: _______________________________ RELIGIÓN: ________________________________________ ESTADO CIVIL: ____________________________________ ESCOLARIDAD: _________________________________ LUGAR DE ORIGEN: ____________________________________ LUGAR DE RESIDENCIA: _______________________________________ OCUPACIÓN: _____________________________ MOTIVO DE LA CONSULTA: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ANTECEDENTES HEREDOFAMILIARES: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ANTECEDENTES PERSONALES NO PATOLÓGICOS: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ANTECEDENTES PERSONALES PATOLÓGICOS: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

UNIVERSIDAD DE QUINTANA ROO/ DIVISIÓN DE CIENCIAS DE LA SALUD CICLOS CLINICOS OTOÑO 2018/ SEDE ISSSTE CHETUMAL

ANTECEDENTES GINECO OBSTÉTRICOS __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ PADECIMIENTO ACTUAL __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ INTERROGATORIO POR APARATOS Y SISTEMAS Síntomas generales __________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Órganos de los sentidos _______________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Cardiorespiratorio ___________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Vascular ___________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Urinario ___________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Genital ____________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Digestivo __________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Hemolinfático ______________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Endocrino _________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Nervioso __________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Psiquiátrico ________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Musculo-Esquelético _________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

UNIVERSIDAD DE QUINTANA ROO/ DIVISIÓN DE CIENCIAS DE LA SALUD CICLOS CLINICOS OTOÑO 2018/ SEDE ISSSTE CHETUMAL

Dermatológico ______________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ EXPLORACIÓN FÍSICA __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ INTERPRETACIÓN DE ESTUDIOS DE LABORATORIO Y GABINETE __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

UNIVERSIDAD DE QUINTANA ROO/ DIVISIÓN DE CIENCIAS DE LA SALUD CICLOS CLINICOS OTOÑO 2018/ SEDE ISSSTE CHETUMAL

DIAGNÓSTICO __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ DIAGNÓSTICOS DIFERENCIALES __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ TRATAMIENTO __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ PRONÓSTICO Para la vida, la función y la estética __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ FIRMA DE QUIEN ELABORÓ:____________________________