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ATENCION CONSULTA EXTERNA

FECHA NOMBRE SEX EDAD FEHA DE HISTORIA


O NACIMIENTO CLINICA

Peso: MC: ………………………………………………………………………………


S:
Talla:
…………………………………………………………………………………………………………………………………
T°: …………………………………………………………………………………………………………………………………
FC …………………………………………………………………………………………………..
O:…………………………………………………………………………………………………………………………
FR ……………………………………………………………………………………………………………………………
PA ……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
Domicilio ………………………………………………………

IDX: .........................................................

Plan: ........................................................................................

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