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FICHA DE DIAGNÓSTICO DE SALUD CHISPAS:

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CNH LOS PEQUEÑUELOS
VITAMINA A:
1.- DATOS DE FILIACIÓN
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Nombres: _____________________ Apellidos: ______________________
Edad: ________ Cédula: ______________ Fecha de Nacimiento: _______
6.- DIAGNOSTICO ODONTOLOGICO
Dirección: ____________________________________
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Representante: ________________________________
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Esquema de vacunación: completo ( ) incompleto ( )
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2.- MEDIDAS ANTROPOMÉTRICAS
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Peso Inicial: _____________ Peso Final: ___________
Talla Inicial: _____________ Talla Final: ___________
7.- TRATAMIENTO ODONTOLOGICO
Hemoglobina Inicial: ____________ Hemoglobina Final: _____________
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3.- DIAGNOSTICO MÉDICO
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_____________________________________________________________ RESPONSABLES:
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____________________________________________________________ Nombres y apellidos Cédula firmas

4.- DIAGNOSTICO NUTRICIONAL


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5.- TRATAMIENTO
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MICRONUTRIENTES Marjorie Vera Choez Representante
SI NO Educadora CNH C.I _____________
C.I: 0926385808

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