Documente Academic
Documente Profesional
Documente Cultură
FICHA DE IDENTIFICACION
Nombre________________________________________ edad_______________
Sexo____________ ocupacin_________________ estado civil_______________
Lugar de origen_____________________________________________________
Lugar de residencia__________________________________________________
Nombre del medico tratante____________________________________________
Interrogatorio
Directo ( )
indirecto ( )
mixto ( )
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
Antecedentes ginecoobstetricos
Menarca______________________
Menstruacin
regular ( )
irregular ( )
si ( ) no ( )
Clicos
si ( ) no ( )
Brusca
si ( ) no ( )
Fluida
si ( ) no ( )
Cogulos
si ( ) no ( )
si ( ) no ( )
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
si ( )
no ( )
Describa___________________________________________________________
Antecedentes traumticos
si ( ) no ( )
Describa___________________________________________________________
Antecedentes fimicos (tuberculosis, tos crnica, flemas o sangre en esputo) si ( ) no ( )
Describa___________________________________________________________
Antecedentes luticos (enfermedades de trasmisin sexual)
si ( ) no ( )
Describa___________________________________________________________
Antecedentes neoplasicos
si ( ) no ( )
Describa___________________________________________________________
Antecedentes alrgicos (alimentos, medicamentos, sustancias, etc.)
si ( ) no ( )
Describa___________________________________________________________
Antecedentes hemorrgicos
si ( ) no ( )
Describa___________________________________________________________
Antecedentes anestsicos
si ( ) no ( )
Describa___________________________________________________________
Antecedentes transfuncionales
si ( ) no ( )
Describa___________________________________________________________
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
si ( ) no ( )
Describa___________________________________________________________
PADECIMIENTO ACTUAL
Motivo de la consulta_________________________________________________
__________________________________________________________________
__________________________________________________________________
Fecha de inicio del padecimiento________________________________________
Presenta dolor____________________ fecha de inicio______________________
Tipo de dolor_____________________ intensidad del dolor__________________
Aumento de volumen______________ tamao de volumen__________________
Presenta sangrado________________ fecha de inicio_______________________
Sitio de sangrado_________________ cantidad___________________________
Coloracin_______________________ tos_______________________________
Tipo____________________________ diarrea____________________________
Numero de evacuaciones___________ consistencia________________________
Mucosidad o sangrado________________________________________________
Fiebre__________________________ grados_____________________________
Escalofros______________________ cefalea_____________________________
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
Fecha de inicio______________________
sintomatologa______________________________________________________
__________________________________________________________________
__________________________________________________________________
Evolucin__________________________________________________________
__________________________________________________________________
Terapia empleada (mdicos o dentistas as como medicamentos prescritos)
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Estado actual_______________________________________________________
SIGNOS VITALES
Tensin arterial________________________________
Frecuencia cardiaca____________________________
Frecuencia respiratoria__________________________
Temperatura__________________________________
Talla________________________________________
Peso________________________________________
CABEZA
Crneo
Mesocfalo ( )
dolicocfalo ( )
Macrocefalia ( )
microcefalia ( )
braquicfalo ( )
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
CAVIDAD BUCAL
LABIOS:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
FRENILLOS:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
MUCOSA YUGAL:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
FONDO DE SACO Y MUCOSA ALVEOLAR VESTIBULAR:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
ENCIA:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
DIENTES
Clase de oclusin
I( )
II ( )
III ( )
Caries
Atricin
Anodoncia
Hipodoncia
Dientes supernumerarios
Hipoplasia del esmalte
Fluorosis
PALADAR:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
LENGUA:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
PISO DE LA BOCA:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
OROFARINGUE:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
CUELLO:
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
DIAGNOSTICO_____________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
PRONOSTICO______________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
PLAN DE TRATAMIENTO
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
___________________________
FIRMA DEL MEDICO
_______________________________
FIRMA DEL PACIENTE O FAMILIAR
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429
Dental R y A
CIRUJANO DENTISTA EGRESADO DE LA UNIVERSIDAD VERACRUZANA
Dr. Jos Absalom Romero Rodrguez. CEDULA AEIE-06429