Nota Medica

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NOTA MEDICA

FECHA: _______________________________

NOMBRE: _________________________________________________ EDAD: ____________________________

ALERGIAS: ____________________________________________________________________________________

PADECIMIENTO ACTUAL :
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EXPLORACIÓN FISICA:

SIGNOS VITALES T/A: _____________ FC: ______________ FR: ________________ TEMP. __________________

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DIAGNÓSTICO: ________________________________________________________________________________

TRATAMIENTO: _______________________________________________________________________________

MANEJO: ____________________________________________________________________________________

OBSERVACIONES
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Nombre y firma de examinador Nombre y firma del paciente

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