C.M.F.
FICHA CLÍNICA Dr. Héctor Castro
Clínica Médica Familiar
Médico y Cirujano Cirujano General 1ª. Ave. 4-78 Zona 1, Jutiapa Clínica 7844 6328 Emergencias: 5834 4247 No. De Historia Clínica
Fecha: _____________________________ Nombre: _______________________________________________________________________ Edad: _____________ Fecha de Nacimiento ______________________________________________________ Estado Civil: _____________ Dirección: _______________________________________________________________ Tel. de Casa: ______________ Celular: _________________ Profesión: _____________________ e – mail: ___________________________________ En caso de emergencia llamar a: _________________________________________________ Tel. __________________ Motivo de la consulta _________________________________________________________________________________________________ _ Historia _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ Revisión por sistemas _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ Antecedentes Personales Médicos _________________________________________________________________________________________________ _ Quirúrgicos _________________________________________________________________________________________________ _ Traumáticos
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Examen Físico _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ Impresión clínica _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ Tratamiento _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ Examenes de Gabinete _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _ _________________________________________________________________________________________________ _
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