7/25/2019 Ficha Clinica en Blanco

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FICHA CLINICA PODOLOGICA FICHA Nro____

Nombre completo: _______________________________________________________________________________Sexo:______Direccin : __________________________________________________________________________________________

Telfono : __________________________F.Nacimiento:____________________________ Edad:____________________ c!pacin :__________________________________________________________________________________________ Centro de deri"acin:________________________________________________________________________________________

Enfermedad #!e padece:

$D HTA Artriti% Artro%i% %teopr tro%:__________________________________&edicamento% :__________________________________________________________________________________________

OBSERVACIONES:

Calzado adecuado Inadecuado Muy inadecuado _____________________________________________ _____________________________________________

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'e%o : _______(ilo%

E%tat!ra :_______mt

N) cal*ado :________

EXAMEN DEL PIE

PULSO PEDIO (+) (-)

Derecho Izquierdo

PULSO TIBIAL (+) (-)

Der Izq

TEMPERATURA

Fra Norm Caliente

PROBL CIRCULATORIOS

Si No

PIEL

Seca Normal Humeda

INDICACIONES:

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FECHA :____/____/________

TRATANTE:

TRATAMIENTO:

ASE'SIAF&ENTACI+N,I&'IE-A DE S/CSNICT&IADES'IC,I-ACI+N/ESECADHE,T&IADES0ASTAD',IDASE'SIA FINA,

T/S:__________________________________________________________________

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SIMBOLOGIA