INSTITUTO MEXICANO DEL SEGURO SOCIAL

DELEGACION ESTATAL EN PUEBLA

HOSPITAL GENERAL REGIONAL NO. 36
Nota Preoperatoria

Fecha y hora______________________
Nombre _____________________________________________NSS_______________
Diagnstico______________________________________________________________
Fecha de la ciruga________________________
Plan quirrgico____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Tipo de intervencin quirrgica_______________________________________________
Riesgo quirrgico__________________________________________________________
Cuidados y plan teraputico preoperatorios_____________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Pronstico _______________________________________________________________

Nombre y firma del Mdico________________________ Matricula_____________

R1CG _________________________________________ Matricula_____________
MIP____________________________________________Matricula____________
(Adaptado de la NOM 004-SSA3-2012)
 INSTITUTO MEXICANO DEL SEGURO SOCIAL
DELEGACION ESTATAL EN PUEBLA
HOSPITAL GENERAL REGIONAL NO. 36
NOTA POSTOPERATORIA
Fecha y hora ______________
Diagnstico preoperatorio _____________________________________________
Operacin planeada__________________________________________________
Operacin realizada__________________________________________________
Diagnstico postoperatorio____________________________________________
Tcnica quirrgica___________________________________________________
__________________________________________________________________
Hallazgos transoperatorios____________________________________________
__________________________________________________________________
Incidentes y accidentes _______________________________________________
__________________________________________________________________
Cuantificacin de sangrado, si lo hubo y en su caso transfusiones_____________
_________________________________________________________________
Plan de manejo y tratamiento postoperatorio inmediato_____________________
_________________________________________________________________
Pronstico_________________________________________________________
Clasificacin de la herida: limpia ( ), limpia con implante ( ), limpia contaminada ( ),
contaminada ( ), Infectada ( ).
Cirujano___________________________Ayudante________________________
Anestesiologo______________________Instrumentista_____________________
Circulante_________________________
Nombre y firma del Mdico________________________ Matricula_____________
R1CG _________________________________________ Matricula_____________
MIP____________________________________________Matricula____________
(Adaptado de la NOM 004-SSA3-2012)