HISTORIA CLÍNICA

IDENTIFICACIÓN DEL PACIENTE

Apellidos y nombres: _____________________________________________
Edad: ______________ Fecha de nacimiento: ____________________
Dirección: _________________________________________________________
Celular: _____________________

MOTIVO DE CONSULTA
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ENFERMEDAD ACTUAL
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ANTECEDENTES PERSONALES
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ANTECEDENTES FAMILIARES
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EXAMEN CLINICO
 Facies:
 Cuello:
 ATM:
DIAGNOSTICO PRESUNTIVO
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DIAGNOSTICO DIFINITIVO
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PLAN DE TRATAMIENTO
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