Prontuario e Anamnese

 

UWOK]VÀWCO OMOK]ODØACHO CKBOWN@ÁÖFX MO U@HCFK]F

Uroktuàrco kµ __________ ________________. ______.  Konf: __________________ _____________________________ ______________________ ______________________ ______________________ __________________ _______ WA. kµ. ___________________ Øraèo Fxpfmcmor ____________ HUB kµ.________ kµ.___________________ ____________/____ _/____ M`t` mf K`shcnfkto _______/__________ _______/_____________/________ ___/________ Xfxo _________________________  K`tur`dcm`mf ______________ ________________________ __________ K` K`hcok`dcm`mf hcok`dcm`mf _____________ ________________________ _______________  ____  Fst`mo Hcvcd _________________ _________________ Urobcssèo ___________ ______________________ ______________________ ________________ _____ ]fdfbokf: ______________ Hfd: ______________ ______________ Fn`cd: ___________ ______________________ _______________  ____  Fkmfrfáo Wfscmfkhc`d ________________________________________________________  ________________________________  _____________________ ______________________ ______________________ ______________________ _____________________ __________ Fkmfrfáo Urobcsscok`d __________ _____________________ ______________________ ______________________ ______________________ _____________  __   _____________________  __________ ______________________ ______________________ ______________________ ______________________ _____________________ __________  _____________________  __________ ______________________ ______________________ ______________________ ______________________ ____________________  _________  Ckmch`mo por ______________________________________________________________ Ckchco mo `tfkmcmo fn _____/_____ _____/__________/______ _____/______ WFXUOKXÀRFD UFDO ]W@]@NFK]O

 Konf __________________ _____________________________ ______________________ ______________________ ______________________ __________________ _______ WA. kµ. __________________ Øraèo Fxpfmcmor ______ HUB kµ._________________/____  ]fdfbokf: ______________ Hfd: ______________ ______________ Fn`cd: ___________ ______________________ _______________  ____  Fst`mo

Hcvcd:

_____________________Hýkjuaf

 ______________________  ___________ ______________________ _______________ ____ WA. kµ. __________________ Øraèo Fxpfmcmor _______ HUB kµ._____________/____  ]fdfbokf: ______________ Hfd: ______________ ______________ Fn`cd: ___________ ______________________ _______________  ____ 

 

@K@NKFXF

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0.Fstà ton`kmo `daun nfmch`nfkto?

| Xcn |

| Kèo.

Pu`cs?

 ____________________  _________ _____________________ _____________________ _____________________ ____________________ ___________________ _________ 7. ]fn `daun po mf `dfrac`? | | Xcn | | Kèo | | Kèo Xfc. Pu`d?  ____________________  _________ _____________________ _____________________ _____________________ ____________________ ____________________ __________

8.]fn ou tfvf ou tfkl` `dfrac` ` pch`m` mf `gfdl`?:   | =. Xu` prfssèo ã:

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Korn`d

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@dt`

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| Xcn |

| G`cx` |

| Kèo |

| Kèo Xfc.

| Hoktrod`m` hon

nfmch`nfkto 6. ]fn ou tfvf `daun progdfn` mf hor`áèo?  ____________________  _________ _____________________ _____________________ _____________________ ____________________ ____________________ ______________ ____

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| Xcn | | Kèo 1. ]fn mc`gftfs? | | Xcn | | Kèo | Kèo Xfc