Historia Cl Nica
1. Ficha de Identificación
Nombre _______________________________________________ Edad_________ Sexo ________
Nacionalidad _________________________ Edo. Civil_____________________
Ocupación ___________________________Lugar de Origen _______________
Lugar de residencia____________________ Domicilio _________________________________________________________________________
Persona responsable: Alejandra Colores Religión _____________
2. Antecedentes
a) Heredo Familiares:
Tuberculosis, Diabetes Mellitus,Hipertensión, Carcinomas, Cardiopatías, Hepatopatías, Nefropatías, Enf.endocrinas,
Enf. Mentales, Epilepsia, Asma, Enf. Hematológicas.___________________________________________________________________________________________________
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