Historia clinica odontologica
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PACIENTE: ____________________________OPERADOR: Juan Carlos Cerón Olivares
SUPERVISO: Dr. Cesar Díaz de Ita.
|LCD |San Lorenzo |
|Turno |Vespertino |
|No. Expediente | |
Estomatología
FECHA
D D M M A ATRIMESTRE Elaboro Juan Carlos Cerón O.
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SUPERVISÓ CESAR A. DIAZ DE ITA_________
Nombre del Docente FIRMA
|I. Identificación del paciente|
Nombre _______________________________________
Género ____ EDAD ____ FECHA DE NACIMIENTO 1 6 1 0 9 7
LUGAR DE NACIMIENTO _______________________
DIRECCION _______________________________________________ TELEFONO___________________ CEL: _________________________
OCUPACION ACTUAL...
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