REPBLICA BOLIVARIANA DE VENEZUELA INSTITUTO VENEZOLANO DE LOS SEGUROS SOCIALES HOSPITAL: JOS A. VARGAS PALO NEGRO EDO. ARAGUA SERVICIO DE PEDIATRA

RDENES MDICASNOMBRE Y APELLIDOS: ________________________________________EDAD: ___________SEXO: ____ UBICACIN: _______________________________________ N HISTORIA: __________________________ FECHA Y HORA PESO: Kg. TALLA: cm. S. C.: m

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