UNIVERSIDAD DE QUINTANA ROO/ DIVISIÓN DE CIENCIAS DE LA SALUD

CICLOS CLINICOS OTOÑO 2018/ SEDE ISSSTE CHETUMAL

NOMBRE DEL ESTUDIANTE: ___________________________________________________________________________

GRADO: ____________________________ HISTORIA CLÍNICA No: _____________________

HISTORIA CLÍNICA
FECHA: _____________________________ HORA: __________________________________
FICHA DE IDENTIFICACIÓN:
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FECHA DE NACIMIENTO: __________________________________________SEXO: _______________________________
RELIGIÓN: ________________________________________ ESTADO CIVIL: ____________________________________
ESCOLARIDAD: _________________________________ LUGAR DE ORIGEN: ____________________________________
LUGAR DE RESIDENCIA: _______________________________________ OCUPACIÓN: _____________________________

MOTIVO DE LA CONSULTA:
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ANTECEDENTES HEREDOFAMILIARES:
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ANTECEDENTES PERSONALES NO PATOLÓGICOS:

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ANTECEDENTES PERSONALES PATOLÓGICOS:

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 UNIVERSIDAD DE QUINTANA ROO/ DIVISIÓN DE CIENCIAS DE LA SALUD
CICLOS CLINICOS OTOÑO 2018/ SEDE ISSSTE CHETUMAL

ANTECEDENTES GINECO OBSTÉTRICOS

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PADECIMIENTO ACTUAL
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INTERROGATORIO POR APARATOS Y SISTEMAS

Síntomas generales __________________________________________________________________________________
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Órganos de los sentidos _______________________________________________________________________________
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Cardiorespiratorio ___________________________________________________________________________________
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Vascular ___________________________________________________________________________________________
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Urinario ___________________________________________________________________________________________
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Genital ____________________________________________________________________________________________
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Digestivo __________________________________________________________________________________________
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Hemolinfático ______________________________________________________________________________________
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Endocrino _________________________________________________________________________________________
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Nervioso __________________________________________________________________________________________
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Psiquiátrico ________________________________________________________________________________________
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Musculo-Esquelético _________________________________________________________________________________
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 UNIVERSIDAD DE QUINTANA ROO/ DIVISIÓN DE CIENCIAS DE LA SALUD
CICLOS CLINICOS OTOÑO 2018/ SEDE ISSSTE CHETUMAL

Dermatológico ______________________________________________________________________________________
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EXPLORACIÓN FÍSICA
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INTERPRETACIÓN DE ESTUDIOS DE LABORATORIO Y GABINETE
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 UNIVERSIDAD DE QUINTANA ROO/ DIVISIÓN DE CIENCIAS DE LA SALUD
CICLOS CLINICOS OTOÑO 2018/ SEDE ISSSTE CHETUMAL

DIAGNÓSTICO
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DIAGNÓSTICOS DIFERENCIALES
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TRATAMIENTO
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PRONÓSTICO Para la vida, la función y la estética

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FIRMA DE QUIEN ELABORÓ:____________________________