Breast Ultrasound Preliminary

Name:_Idelaida Rosa Lopez ___

D.O.B: 2/1/79

Age: 37

L.M.P: 10/12/16

Date:10/22/16

Sex: M / F

Height: 53 Weight: 185

G:1 P:0 A:0 CS:1 ECT:0 Taken Hormones: Y/ N

Medical Conditions:
_______N/A__________________________________________________________________
Medicine in use:
_____N/A_________________________________________________________________
Any Previous Operations:
_____N/A_____________________________________________________________________
Comments:_________________________________________________________________

Lupectomia:____ Mastectomia:_____ Reduccion:____

Technician: _Rosaliyvette Reynoso_