CAB.MED.IND..DR.

ALEXIU SANDRA ADALGIZA

JILAVA ILFOV

CNP
B.Id. al mamei

ALERGII:_______________________

FI DE CONSULTAII MEDICALE COPII

NR._____
Numele_________________________Prenumele____________________________________________________
DOMICILIU:
localitate________________________
Data naterii:____________________
Prenumele:
Strada_______________________________Nr._________________
tatlui____________vrsta__
Alimentat natural DA / NU ________luni
mamei____________vrsta__
Malformaii congenitale ____________________________________
Rangul copilului_________________
AHC____________________________________________________
Nscut la ________sptmni/termen
____________________________________________________
Greutate la natere/externare_______
APP ____________________________________________________
Talia la natere/externare__________
____________________________________________________
Asistena la natere______________
____________________________________________________
Starea la natere_________________
____________________________________________________

IMUNIZRI :

BCG

DTP

VPOT

MMR

AHB

ALTELE

PROFILAXIE

4-5 zile

2luni

2luni

12luni

24h

AHA (I)
(HAVRIX JR.)

Rahitism

4luni

4luni

2luni

AHA (II)
(HAVRIX JR.)

6luni

6luni

6luni

Ahib>1 an
(ActHib)

1an

1an

Avar
(Varilix)
Antigripal

2,5ani
Cls.I
Cls.VIII

An. hipocrom

Cls.III

Cls.I

Carie dentar

Etc.

Cls.III

Cls.VIII

DEZVOLTARE / VRSTA N LUNI

1
0

1
1

1
2

1
3

1
4

1
5

1
6

1
7

Privete chipurile
X X
ine capul la 90 grade
X X X X X
Surde spontan
X X X X X
Rde in hohote
X X X X
Urmrete cu privirea 180
X X X X
grade
Se ntoarce pe o parte
X X X X
i privete minile
X X X X
Gngurete
X X X X
Apuc un obiect oferit
X X X
ntinde mna
X X X
ntinde mna i apuc un
X X X X
obiect
Imit sunetele
X X X X X X
Recunoate persoanele
X X X X
Se aeaz singur
X X X X X X X X X
Se ridic n picioare cu
X X X X X X X X
sprijin
Merge cu sprijin
X X X X X X X X

1
8

Merge singur
Se ridic in picioare singur

X X X X X X X X
X X X X X X X