Judetul……………………….

Localitatea …………………..
Unitatea sanitara ……………….

Fişă de consultaţii medicale

- copii -

Numele ………………………………. Prenumele ………………………………………………….. Sexul M / F

Data naşterii ‫ ……… ׃‬luna ……………. Ziua …………
Domiciliul ‫ ׃‬localitatea ……………………….. Str. ……………………….Nr. ….. Bl. ……. Sc. …… Ap. …….

ANAMNEZA

Antecedente fiziologice Alimentat natural pana la ………………

Rangul copilului …………. Malformatii congenitale ……………….
Nascut la …….. luni ………………………………………….
Greutatea ……………grame Antecedente patologice …………………
Lungime ………….. cm …………………………………………..
Asistat la nastere da / nu Antecedente familiale …………………..
Starea la nastere / Apgar ………. …………………………………………..

DATA EFECTUARII IMUNIZARILOR

VACCINARI
BCG Hep.B A.P. DiTe DiTPer A.T. Atpa Antirujeolic Antitifoidic Antigripal

REVACCINARI
BCG Hep.B A.P. DiTe DiTPer A.T. Atpa Antirujeolic Antitifoidic Antigripal

CONSEMNAREA EXAMENELOR PERIODICE

Concluziile examenului clinic, aspecte morfofunctionale
Varsta ale nou-nascutului, examenul analizatorului acustic si vizual
______________________________________________________________________________________________________
15 zile Greutatea ………………….. Stare generala buna, afebrile, t= C. FP inchisa, FA deschisa.
Inaltimea …………………. Tegumente si mucosae normal colorate. Sistem ganglionar
P.C. ……………………….. nepalpabil.
P.T. ………………………. Ap. digestiv – abdomen nedureros la palpare, transit intestinal
Examen de bilant la externare prezent, scaune normal colorate.
Ap. cardiovascular – zgomote cardiace ritmice, suflu sistolic absent.
Ap. respirator – murmur vezicular present, raluri absente.
Ap. urogenital – loje renale libere, mictiuni spontane.
Clinic sanatos.
_____________________________________________________________________________________________________
Varsta Evenimente deosebite survenite de la ultima examinare. Concluziile examenului clinic. Dezvoltarea
neuro-psihica. Examenul organelor de simt
____________________________________________________________________________________________
2 luni Greutatea …………………..
Inaltimea ………………….
P.C. ………………………..
P.T. ……………………….
____________________________________________________________________________________________
4 luni Greutatea …………………..
Inaltimea ………………….
P.C. ………………………..
P.T. ……………………….
______________________________________________________________________________________________________

6 luni Greutatea …………………..

Inaltimea ………………….
P.C. ………………………..
P.T. ……………………….
______________________________________________________________________________________________________

8 luni Greutatea …………………..

Inaltimea ………………….
P.C. ………………………..
P.T. ……………………….
______________________________________________________________________________________________________

12 luni Greutatea …………………..

Inaltimea ………………….
P.C. ………………………..
P.T. ……………………….

Consultatii, investigatii
Data Simptome Diagnostic Prescriptii, recomandari

_____________________________________________________________________________________
Data Simptome Diagnostic Prescriptii, recomandari

_____________________________________________________________________________________
Data Simptome Diagnostic Prescriptii, recomandari
_____________________________________________________________________________________
Data Simptome Diagnostic Prescriptii, recomandari

Consultatii, investigatii

Data Simptome Diagnostic Prescriptii, recomandari

_____________________________________________________________________________________
Data Simptome Diagnostic Prescriptii, recomandari

_____________________________________________________________________________________

Data Simptome Diagnostic Prescriptii, recomandari

_____________________________________________________________________________________

Data Simptome Diagnostic Prescriptii, recomandari

_____________________________________________________________________________________

Data Simptome Diagnostic Prescriptii, recomandari

_____________________________________________________________________________________

Data Simptome Diagnostic Prescriptii, recomandari

_____________________________________________________________________________________

Data Simptome Diagnostic Prescriptii, recomandari

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