Professional Documents
Culture Documents
l. INTERROGATORIO:
Directo: ( ) Indirecto ( )
Nombre y parentesco del informante (en caso de no ser el paciente)
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FICHA DE IDENTIFICACIN
Nombre del paciente:
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Apellido paterno Apellido materno Nombre(s)
Escolaridad:_____________________ Religin:________________________________
ANTECEDENTES
Antecedentes heredo-familiares: (abuelos, padres, tos, cnyuge, hijos, primos). Investigar: DM,
enfermedades tiroideas, HTA, cardiopatas, nefropatas, enfermedades broncopulmonares,
neurolgicas mentales, enfermedades infectocontagiosas, reumticas y neoplsicas.
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Antecedentes personales no patolgicos:
Alimentacin:
Pecho materno: Duracin: meses. Ablactacin: meses
si no
Verdura Leguminosa
s: s Agua _______________
Habitacin: tipo de vivienda (jacal, departamento, vecindad, casa sola); distribucin de la vivienda
(nmero de cuartos y servicios, nmero de personas por habitacin, convivencia con animales, tipo y
nmero); higiene de la vivienda (iluminacin, ventilacin); bao (intra o extradomiciliario, individual o
compartido).
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Hbitos higinicos individuales (aseo personal, bao, cambio de ropa, lavado de manos, aseo dental).
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Perinatales
Anestesia: Cual:
si no
PADECIMIENTO ACTUAL
Motivo y circunstancia de la consulta.
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Estudios paraclnicos realizados. Resultados:
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Cabeza
Crneo: inspeccin, palpacin, percusin y, si es necesario, auscultacin.
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Cara: inspeccin, palpacin percusin y, si es necesario, auscultacin.
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Ojos:
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Odos:
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Nariz:
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Boca:
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Cuello: inspeccin, palpacin percusin y, si es necesario, auscultacin.
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