Ficha clínica

Nombre:__________________________________________

Fecha de nacimiento:_______________________________

Edad:______________________________

Rut:____________________

Estado civil:_______________

Ocupación:___________________

Fecha de ingreso:___________________

Fecha de egreso:_____________________________

Diagnostico actual:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Antecedentes mórbidos_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Tipo de Tratamiento

farmacologico______________________________________________________

.quirurgico_________________________________________________________

.kinesico___________________________________________________________

Anamnesis próxima

Motivo de la consulta:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Objetivo del paciente para asistir a terapia_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Evaluación, inspección , palpación:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Observaciones: ________________________________________________________________________________________________________________________________________________________________________________________________________